IMT Interview > IMT > Flashcards

IMT Flashcards

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1
Q

Chest pain immediate management

A

A-E
ECG, Troponin, D Dimer
Analgesia
IV Fluids if needed
CTPA and DOAC if PE

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2
Q

Alcohol withdrawal immediate management

A

GMAWS (Glasgow Modified Alcohol Withdrawal Score)
Start a benzodiazepine regimen (chlordiazepoxide if can swallow, IV Lorazepam if not)
IV Pabrinex then switch to PO Thiamine
Correct electrolyte abnormalities
Referral to addiction services

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3
Q

UGIB immediate management

A

Stop warfarin
Start IV Terlipressin
IV Antibiotics
OGD once haemodynamically stable
Blood products if needed
Band ligation if needed

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4
Q

Scoring systems for UGIB

A

Glasgow Blatchford - for need of intervention
Child Pugh - assessment of liver disease
HAS BLED - bleeding risk of anticoagulation
Rockall score - post endoscopy risk of rebleeding and mortality

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5
Q

DVT immediate steps

A

A-E
Doppler ultrasound of affected leg
CTPA if PE
LMWH or DOAC unless contraindicated
Monitor for signs of PE

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6
Q

Should DVTs be admitted

A

If no signs of haemodynamic compromise or PE can be managed with ambulatory pathway

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7
Q

Anaphylaxis immediate steps

A

A-E
IM 0.5mg Adrenaline
15l O2
IV Fluids
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV
Prepare ITU/ Advanced airway management

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8
Q

Anaphylaxis further possible treatment

A

Nebulised salbutamol
Intubation
Adrenaline infusion
Observe for 4-6hrs in case of biphasic
Discharge with epipens
Referral to allergy services

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9
Q

Bradycardia immediate steps

A

A-E
12 lead ECG
IV Atropine 500mcg up to 3mg
IV Isoprenaline or pacing
Refer cardio
(correct electrolytes, echo for structural abnormalities)

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10
Q

Pneumothorax immediate steps

A

A-E
15l Oxygen
Needle decompression if tension
CXR
Pain relief
Consider conservative if <2cm and stable
Resp follow up, no flying or scuba diving

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11
Q

DKA immediate steps

A

A-E
Fluids
Insulin (0.1 units/kg/hr)
Monitor glucose and potassium levels

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12
Q

Seizure immediate steps

A

Recovery position, protect the airway
Buccal midazolam 10mg if >5 mins
Bloods
Triggers and first fit clinic referral

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13
Q

AF immediate steps

A

12 lead ECG
Rate control with beta blocker unless contraindicated

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14
Q

Contraindications for AF beta blocker rate control

A

Reversible cause
Heart failure
Onset in last 48hrs
Rhythm control more appropriate (discuss with cardiology)

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15
Q

AF risk scores

A

CHADSVASc for anticoagulation
ORBIT for bleeding risk

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16
Q

Causes of AF

A

Structural heart disease
High blood pressure
Ischaemic heart disease

Systemic illness
Thyrotoxicosis
Obesity
OSA
Electrolyte abnormalities
Idiopathic

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17
Q

COPD immediate steps

A

A-E
Oxygen via venturi 88-92
CXR ABG
Signs of retention - confusion
Septic screen
Salbutamol 5mg Ipratropium 500mcg nebulised
Prednisolone 30mg or Hydrocortisone IV (5-7 days)
Viral screen
Admission
NIV if hypercapnia or acidosis persists despite initial treatment
Smoking cessation

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18
Q

Paracetamol OD immediate steps

A

A-E
Paracetamol levels 4hrs post ingestion and check for treatment as per nomogram
VBG- pH and lactate
LFTs and clotting - INR
N-Acetyl-Cysteine (if above treatment level, evidence of hepatotoxicity or OD timing unclear)
Activated charcoal (if in past hour and patient cooperative)
Supportive care - look for hypoglycaemia or encephalopathy
Psych Liaison

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19
Q

When would you refer a paracetamol OD for a liver transplant

A

Acute liver failure or meeting kings college criteria
-pH under 7.3
or all three of
-INR >6.5
-Creatinine >300
-Grade 3 or 4 hepatic encephalopathy

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20
Q

Gout immediate steps

A

A-E
NSAIDs (+PPI), Colchicine or steroids
Arrange joint aspiration to exclude septic arthritis
Uric acid level
Medication review
Allopurinol after acute episode

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21
Q

Hyperkalaemia immediate steps

A

12 lead ECG
Continuous cardiac monitoring
IV Calcium gluconate
Insulin dextrose infusion
Nebulised salbutamol
Calcium resonium
Stop ACE-I, ARB, Spironolactone, NSAIDs
Nephrology for dialysis if refractory

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22
Q

Asthma immediate steps

A

15l Oxygen
5mg Salbutamol and 500mcg ipratropium every 20 mins
Peak flow
IV Hydrocortisone 100mg / Prednisone 40-50mg
CXR and ABG
IV Magnesium sulphate if severe
IV aminophylline / salbutamol infusion if refractory
Prepare for intubation/ITU

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23
Q

Aortic dissection immediate steps

A

A-E
Aggressively bring BP down, <120 systolic, IV sotalol
Morphine
CT Aortagram
ECG
IV nitroprusside for BP if needed
Refer cardiothoracic surgery

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24
Q

UTI immediate steps

A

A-E
Septic screen
Urine dip and MC&S
Pregnancy test
Antibiotics for UTI (nitro/ trimethoprim)
Uncomplicated= discharge
Complicated= IV antibiotics
Analgesia
Drink plenty of fluids

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25
Pericarditis immediate steps
A-E 12 lead ECG Troponin Analgesia Echocardiogram NSAIDs and Colchicine See improvement on NSAIDs/Colchicine before discharge
26
Alcohol withdrawal immediate steps
A-E Chlordiazepoxide as per GMAWS protocol Thiamine/ Pabrinex B Vitamins Mg supplementation Monitoring as per GMAWS and replace any electrolyte deficiencies
27
Hypertensive urgency immediate steps
A-E Neurological examination Cardio examination ECG Bloods Urine dip Fundoscopy Amlodipine stat dose Outpatient if no signs of end organ damage Lifestyle modification advice
28
Pallor investigations
FBC U&E LFT Peripheral blood smear Coombs test
29
Fragmented red blood cells, spherocytes and polychromasia cause
Autoimmune haemolytic anaemia
30
Autoimmune haemolytic anaemia differential diagnosis
Microangiopathic haemolytic anaemia Hereditary spherocytosis Infections G6PD deficiency
31
Acute haemolytic anaemia immediate steps
A-E Blood transfusion Group and save Coombs test Reticulocyte count Haem advice Hydration, Renal Function, Haem advice
32
UC immediate steps
A-E FBC, U&E, LFT, CRP Stool sample and for C Diff AXR IV fluids IV hydrocortisone Gastro referral Consider Abx Electrolytes, pain relief, nutrition
33
Abx for C difficile
Vancomycin And metronidazole if severe
34
Meningitis immediate steps
A-E IV Ceftriaxone and IV Aciclovir Lumbar puncture CSF for microscopy, glucose, protein and viral PCR Isolation Paracetamol, fluids, rest
35
Syncope immediate steps
A-E Full cardiovascular and neurological examination FBC, U&E, CRP, LFT, Glucose, Troponin ECG Hydration, trigger avoidance Cardiology referral
36
SBP immediate steps
A-E Empirical antibiotics - cefotaxime FBC, U&E, LFT, Clotting, INR, CRP, blood cultures Diagnostic paracentesis Thiamine replacement Urine dip & CXR Refer hepatology IV Albumin Ascitic drain Lactulose if HE, supportive care
37
Migraine immediate steps
A-E Full neurological examination Reduce triggers Analgesia Rule out red flags
38
Signs of pulmonary oedema on CXR
Alveolar oedema Kerley B Lines Cardiomegaly Dilated upper lobe vessels Pleural effusions
39
Analgesia for migraine
Acute- paracetamol, NSAIDs, triptan Prevention- beta blockers, topiramate Lifestyle changes
40
Hypoglycaemia immediate steps
A-E Glucose, U&E, LFT, VBG, CRP Oral glucose IV dextrose IM Glucagon if access difficult
41
Differential of hypoglycaemia in diabetic
Insulin induced Sulfonylurea induced Alcohol related Adrenal insufficiency Insulinoma
42
Hyponatraemia immediate steps
43
Causes of hyponatraemia
Hypovolaemia -slow fluid replacement to avoid central pontine myelinosis Euvolaemic -paired osmolalities and fluid restriction -SIADH, hypopituitary and hypothyroidism Hypervolaemic -Kidney, liver or heart failure (fluid restriction and diuretics)
44
Hyponatraemia/ SIADH immediate steps
A-E TFTs, Cortisol, Paired osmolalities Fluid restrict Monitor sodium levels Avoid rapid correction (can give hypertonic saline if severe)
45
Causes of SIADH
SSRIs SCLC CNS- Stroke, meningitis Pulmonary infections Primary polydipsia
46
Neutropenic sepsis immediate steps
A-E Blood, sputum and urine cultures Broad spectrum abx- pip taz IV fluids Sepsis 6 Lactate, liver function, PT/APTT/INR Refer oncology Growth factor support, can adjust abx according to cultures
47
Cellulitis immediate steps
A-E Sepsis 6 Analgesia Mark the border of the rash FBC, U&E, CRP, Blood cultures Doppler to exclude DVT Swab for MC&S Elevate the leg Avoid compression VTE prophylaxis
48
Acute heart failure immediate steps
A-E Sit up High flow oxygen IV Furosemide Cardiac monitoring Consider NIV 12 lead ECG CXR Echo Urine output Weight Consider vasodilators or ionotrope support
49
Stroke immediate steps
A-E Activate stroke protocol, contact stroke nurses Neurological assessment CT Brain FBC, U&E, Coagulation studies, glucose, troponin ECG Thrombolysis/ Thrombectomy Aspirin if outside 4.5hrs BP management Hydration, nutrition, normoglycemia Early mobilisation, SALT input
50
What is the window for thrombolysis and contraindications
4.5hrs Prior stroke in last 3 months Major surgery Intracranial haemorrhage Severe hypertension Active bleeding Low platelets History of prior intracranial haemorrhage
51
ACS immediate steps
A-E MONA -Morphine, Oxygen, GTN, Aspirin 300mg Aspirin and 300mg Clopidogrel and PPI ECG Troponin PCI if STEMI confirmed IV Nitrates if BP allows for pain Refer cardiology Thrombolysis if no PCI in 120 minutes BB, ACE-I and Statin long term
52
Pneumonia immediate steps
A-E CXR and ABG Blood and sputum cultures Fluid, Antibiotics FBC, U&E, LFT, CRP Urinary catheter Consider NIV
53
AKI immediate steps
A-E Pre renal, renal or post renal Fluid balance monitoring FBC, CRP, U&E, LFT Urine dip, Urine ACR Stop medications
54
Acronym for stopping drugs in AKI
SADMANS -Sulfonylureas -ACE-I -Diuretics -Metformin -ARBs -NSAIDs -SGLT2s
55
GCA immediate steps
A-E Neuro and Opthalm examination High dose corticosteroids Urgent opthalmology referral Temporal artery biopsy +- ultrasound Calcium and vitamin D supplementation Rheumatology review
56
Delirium immediate steps
A-E Practical steps- ensure safety, consider sedation, orientate, reassure, collateral history Review meds, confusion screen blood tests (FBC, U&E, CRP, LFT, TFT, B12, Folate, ammonia), sepsis screen CT Head
57
UGIB immediate steps
A-E Major haemorrhage protocol Reverse thrombolytics ABG, VBG, FBC, U&E, CRP, LFT, Clotting, Group and Save Escalate to gastroenterology IV Terlipressin IV PPI if not variceal bleeding IV antibiotics Blood/ platelets if required
58
Stroke initial steps
Alert stroke team A-E 300mg Aspirin If within 4.5 hrs and no contraindications to thrombolysis then alteplase Normoglycaemia, normal oxygen SLT, Physio, OT
59
Anticoagulation in Stroke
CHADSVASC2 if AF But not for the first 30 days Aspirin 300mg OD
60
What classifications are there for strokes
Bamford -Total Anterior Circulation Stroke -Partial Anterior Circulation Stroke -Posterior Circulation Stroke -Lacunar Stroke NIHHS is symptom based and can be used for prognosis
61
BP Control in Stroke
Talk to senior Not in ischaemic Can be considered on case by case basis in haemorrhagic
62
Septic Arthritis immediate steps
Joint aspiration (if native joint) -for gram stain and culture Consider XR IV Flucloxacillin Discuss ortho Sepsis 6
63
Septic arthritis most common bacteria
Staph Aureus Young people - neisseria gonorrhoea
64
VBG in sepsis
Lactate being raised would be expected Early antibiotics and fluids would be vital
65
Signs of a life threatening asthma attack
SpO2 <92% pAO2 < 8 kpa Normal paCO2 Altered level of consciousness Exhaustion Arrythmia Hypotension Cyanosis Silent chest Poor respiratory effort
66
ITU requirements for Asthma
Require ventilatory support Deteriorating peak flows Worsening hypoxia Hypercapnia Acidosis on ABG Exhaustion Drowsiness Respiratory arrest
67
Falls history
Before, during and after Social history Systems review
68
Structure for any history
Before During After Past medical history Past drug history Social history Family history Systems review
69
TIA Treatment
Lifestyle modification Clopidogrel High dose statin Antihypertensives
70
Hypercalcaemia immediate steps
Bloods inc Calcium, Parathyroid Hormone, Bone profile, TFTs, Magnesium, Vitamin D and myeloma screen. ECG Aggressive fluid resuscitation, monitor urine output then give IV bisphosphonates
71
Hypercalcaemia need for senior review
Confusion, Drowsy Calcium over 3.5 Dropping urine output despite fluids ECG- Arrythmia or QT changes Rising Creatinine
72
Lung cancer investigations
CXR Then CT TAP Then tissue biopsy is required Staging requires PET-CT
73
Complications of lung cancer to look for
SVC Obstruction - facial swelling, venous distension and SOB Tumour erosions- haemoptysis Post obstructive pneumonia Hypercalcaemia- confusion, constipation, polyuria Brain mets - headaches, focal neurology or seizures Spinal cord compression
74
Lung cancer paraneoplastic syndromes
SIADH Cushings Lambert-Eaton myasthenia
75
Performance status 0
Fully independent
76
Performance status 4
Bed bound
77
HHS immediate steps
VBG, Bloods, Exclude sepsis Need to slowly rehydrate to avoid cerebral pontine myelinosis Insulin once glucose stops falling with hydration alone
78
Complications of HHS
Cerebral oedema, stroke, AKI, Thromboembolism due to hyper viscosity, aspiration pneumonia, arrhythmia and electrolyte abnormalities
79
What is it important to explain to old patients with Diabetes
Sick day rules so that they don't develop HHS
80
Treatment of severe c diff
Oral vancomycin and IV Metronidazole and speak to senior
81
Would you send faecal calprotectin in an acute setting
No, it can not differentiate between acute colitis and inflammatory bowel disease, this could be considered in the outpatient setting after the acute episode
82
How do you differentiate thyroid storm and thyrotoxicosis
Burch-Wartofsky point scale Thyroid storm is less severe symptoms
83
Thyroid storm management
Call on call endo and send to HDU Propanolol, propylthiouracil, Lugols iodine and hydrocortisone
84
What is the most important side effect from hyperthyroid treatment
Agranulocytosis from Carbimazole
85
Definitive hyperthyroid treatments
12 months antithyroid Thryoidectomy or partial thyroidectomy
86
Differential questions for pleural effusion
Infection Malignancy Heart failure Thromboemolism Autoimmune Occupational exposure Drug Histor
87
When do you defer transudative effusion
If small, bilateral, clear transudative cause or contraindications
88
Causes of hyponatraemia
Hypovolaemic -dehydration -furosemide induced -losses Euvolaemic -SIADH -Adrenal insufficiency -Hypothyroid Hypervolaemic -dilutional, heart failure -liver failure -CKD
89
SIADH induced drugs
PPIs NSAIDs SSRIs Diuretics ACE-I and ARB
90
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