33 Questions
Define the King’s College criteria.
The King’s College criteria are used to predict the risk of death or transplantation in cases of acetaminophen (Tylenol) toxicity.
Explain the initial approach to resuscitation for a neonate presenting febrile and in shock.
The initial approach involves correcting glucose levels, giving fluid, administering antibiotics, and starting pressors. If the neonate remains hypotensive, hydrocortisone might be considered.
Describe the management of a hemodynamically unstable calcium channel blocker overdose.
The management involves aggressive measures such as calcium chloride or calcium gluconate, high-dose insulin therapy, and possibly lipid emulsion therapy.
What are the causes of a temporary PEA cardiac arrest in a patient with Type 1 DM, fever, and DKA?
Possible causes include acidosis, respiratory decompensation, and hyperkalemia.
Explain the mechanism of bradycardia in a patient with an inferior STEMI.
The bradycardia could be due to increased vagal tone resulting from the inferior myocardial infarction.
List all elements of the PERC rule and explain what a negative PERC rule means.
The elements of the PERC rule include age, pulse, SaO2, and clinical assessment. A negative PERC rule means that the likelihood of a pulmonary embolism is low.
List the elements of the Ranson Criteria for pancreatitis on admission (specific values)?
Age > 55, WBC > 16,000/mm3, Blood glucose > 200 mg/dL, LDH > 350 U/L, AST > 250 U/L
Management considerations in traumatic hyphema and globe rupture?
Traumatic hyphema: bed rest, eye protection, cycloplegic agents. Globe rupture: urgent surgical repair, antibiotics, tetanus prophylaxis.
X-ray features of SCFE?
Widened and irregular epiphyseal plate, decreased density at the epiphyseal plate, and posterior and inferior displacement of the epiphysis.
Describe the Young and Burgess classification of pelvic fractures?
The Young and Burgess classification categorizes pelvic fractures into lateral compression, anteroposterior compression, and vertical shear.
Diagnosis and management of PID?
Diagnosis: clinical findings, cervical motion tenderness, and adnexal tenderness. Management: antibiotics to cover Chlamydia trachomatis and Neisseria gonorrhoeae.
Different classifications of HTN in pregnancy?
Chronic hypertension, gestational hypertension, preeclampsia, and eclampsia.
Describe how to do retrograde cystogram?
Retrograde cystogram involves instilling contrast into the bladder via a catheter, followed by taking X-rays while the patient voids.
Describe the stages of syphilis and treatment of secondary syphilis?
Stages: primary (chancre), secondary (rash, mucocutaneous lesions), latent, and tertiary (gummatous, neurosyphilis). Treatment of secondary syphilis: Benzathine penicillin G.
List elements of offline medical control?
Offline medical control involves physician consultation, medical direction, and oversight of prehospital care.
Pregnant patient exposed to varicella – how to manage?
Administer varicella zoster immune globulin (VZIG) within 96 hours of exposure; if VZIG is unavailable, administer varicella vaccine postpartum.
List 5 characteristics of a simple febrile seizure.
Brief duration, occurs in children 6 months to 5 years old, generalized tonic-clonic seizure, no neurologic deficits post-seizure, no underlying CNS infection or other cause.
Other than pancreatitis, what are 5 causes of increased lipase?
Pancreatic cancer, biliary tract obstruction, peptic ulcer disease, intestinal ischemia, renal failure.
Describe the stages of syphilis and the treatment of secondary syphilis.
Primary (painless chancre), secondary (rash, mucocutaneous lesions), latent (asymptomatic), tertiary (gummas, neurosyphilis), Treatment: Benzathine penicillin G.
List 17 causes of urinary retention (given a table with different broad categories).
Prostate enlargement, medications (anticholinergics, opioids), neurogenic disorders (e.g., spinal cord injury), urethral stricture, constipation, bladder outlet obstruction, pelvic organ prolapse, urinary tract infection, bladder cancer, postoperative retention, psychological causes, urethral injury, diabetes, alcohol, pregnancy, radiation, stool impaction.
Describe the management of a drug overdose that was likely calcium channel blocker.
The management of a hemodynamically unstable calcium channel blocker overdose involves aggressive fluid resuscitation, vasopressors (e.g. high-dose insulin), calcium for cardiac stabilization, and potentially lipid emulsion therapy.
Explain the initial approach to resuscitation for a neonate presenting febrile and in shock.
The initial approach to resuscitation for a febrile and shock-presenting neonate involves correcting glucose, giving fluids, administering antibiotics, starting pressors, and considering hydrocortisone if no other cause of shock is apparent.
Describe the stages of syphilis and treatment of secondary syphilis.
The stages of syphilis include primary, secondary, latent, and tertiary. The treatment for secondary syphilis involves benzathine penicillin G.
List the elements of the Ranson Criteria for pancreatitis on admission (specific values).
The elements of the Ranson Criteria for pancreatitis on admission include age, WBC count, blood glucose, LDH, AST; specific values are required for each element.
What are the causes of a temporary PEA cardiac arrest in a patient with Type 1 DM, fever, and DKA?
The causes of a temporary PEA cardiac arrest in a patient with Type 1 DM, fever, and DKA can include acidosis, respiratory decompensation, and hyperkalemia.
Explain how to manage a homeless man found unconscious and hypothermic in a snowbank, who requires active internal rewarming and then has a VF cardiac arrest.
The management involves active internal rewarming, followed by advanced cardiac life support (ACLS) guidelines for the treatment of ventricular fibrillation (VF) cardiac arrest.
Describe the management of a 5-year-old with severe asthma that requires intubation, including the subsequent ventilation settings.
The management involves describing the process of intubation and the subsequent ventilation settings, which may include tidal volume, respiratory rate, and positive end-expiratory pressure (PEEP).
Explain the approach to an older male patient diagnosed with an inferior STEMI, who becomes bradycardic and hypotensive, and requires management using ACLS.
The approach involves managing the bradycardia and hypotension using ACLS protocols, while considering the potential mechanisms of the bradycardia in the context of an inferior STEMI.
Describe the approach to a sedation scenario where a colleague is stealing fentanyl, resulting in a patient not receiving the expected analgesia, and the intoxicated physician is still seeing patients.
The approach involves addressing the patient who did not receive the expected analgesia, managing the intoxicated physician who is still seeing patients, and addressing the potential harm to all other patients seen by the intoxicated physician.
List the differential diagnosis and provide a final diagnosis for a male in his 20s who has been generally unwell, weak for 2 weeks, has a cough and fever, and presents with petechiae and a WBC count of 185.
The differential diagnosis includes leukemia/blast crisis with concurrent pneumonia from immunosuppression. The final diagnosis is based on clinical and laboratory findings.
Provide a differential diagnosis for a lady in her 50s with epigastric/RUQ pain and hemodynamic instability, and a subsequent diagnosis of ascending cholangitis.
The differential diagnosis may include various conditions causing epigastric/RUQ pain, while the diagnosis of ascending cholangitis requires prompt recognition and intervention.
What is the response to a consultant who delays ERCP for a patient with ascending cholangitis?
The response involves advocating for urgent intervention due to the high risk of complications and the potential for rapid deterioration in patients with ascending cholangitis.
Criteria for Depression
A) Depressed mood or anhedonia with ≥ 5 of the following for ≥ 2 weeks : M SIGECAPS
- Mood depressed*
- Sleep increased or decreased
- Interest decreased (anhedonia)*
- Guilt
- Energy decreased
- Concentration decreased
- Appetite increased or decreased
- Psychomotor increased or decreased
- Suicidal ideation
B) Functional impairment C) Not due to a GMC / medication / substance
- Not due to a mixed episode / bereavement
- at least one of
Test your knowledge of clinical medicine with questions on Ranson Criteria, traumatic hyphema, SCFE, pelvic fractures, PID, hypertension in pregnancy, retrograde cystogram, syphilis stages, offline medical control, and management of pregnant patients with medical emergencies.
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