Medical Emergencies for Examinations Aneil Maanay
INDEX
A
Acidosis 94
Acute asthmatic episode 49
Acute attack 70
Acute coronary syndrome 31
Acute epiglottitis 13
Acute pump failure 27
Acute renal failure 48, 117
Acute SOB 43
Adrenal crisis 29
Airway management 12
Airways 3,4
Altered consciousness in hepatic disease 113
Amiodarone 21
Anaphylactic shock 28
Angioplasty 32
Anion gap 124
Antibiotics 50
Anticoagulation for atrial fibrillation 22
Antisnake venom serum 152
Aortic regurgitation 33
Arrhythmias 35
Arterial blood pH 91
Asystole 10
Atrial fibrillation 87
Atropine 10
B
Beta-blockers 21, 38
Blephoras 64
Blood glucose 81
Blood pressure 39
Blood urea 117
Bowels 64
Bradyarrhythmias 36
Bradycardias 23
signs and symptoms 23
Brain diseases 69
abscess 69
CVA 69
encephalitis 69
tumour 69
Brain pathology 69
Breathing 3
Broad complex tachycardia 15
C
Calcium antagonists 21
Calcium level in hypocalcemia 87
Cardiac massage 4
Cardiogenic shock 26
arrhythmogenic 26
pump failure 26
Carotid pulse 3
Cause of aspiration 55
Cause of bleeding 107
Causes of new murmur in an AMI 33
Causes of pneumothorax 46
Changes of hyperkalemia 124
Chest pain 30
cardiac 30
non-cardiac 30
Chloroquine/quinine toxicity 17
Cholera and dehydration 162
Chronic bronchitis 50
Circulation 3
Clofazimine 163
CMV 100
CNS infections 101
Cocaine abuse 144
Commandments of poisoning 133
Complex tachycardias 14
Complications of AMI and thrombolysis 32
Complications of warfarin 128
Contraindications for thrombolysis 64
Convulsions 65
CPR 5
Cryptococcal meningitis 101
CT scan of brain 62
Cystic fibrosis 54
D
D-dimers 128
Diabetic emergencies 80
Diagnosis of diabetic ketoacidosis 77
Dietary sources of potassium 124
Digitalis toxicity 139
Digoxin 21
Digoxin toxicity 17
Diltiazem 18, 21
DKA 92
Dog bite 155
Doses of shock in pulseless VT/VF 7
Duodenal and gastric bleeding 109
acute erosive gastritis 109
gastric tumours 109
peptic ulcer 109
E
Eclampsia 40
Endotracheal intubation 12
Epinephrine 10
Erythema nodosum leprosum 163
Exacerbation of chronic airway disease 50
Exchange transfusion 150
F
Fibrillation 144
Flumazenil 59
Forced alkaline diuresis 138
Fungi 101
G
Gastric lavage 134
Gastrointestinal infections 101
Gingival infection 101
H
Haemophilus influenzae 98
Headache 67
Headaches with focal signs 69
Headaches with neck stiffness 68
meningitis 68
subarachnoid hemorrhage 68
Heart failure 88
Heart rate 89
Heat stroke 164
classic heat stroke 164
exertional heat stroke 164
treatment 164
Heavy metals 136
Hematemesis 107, 119
Hemoglobinemia 121
Hemolytic uremic syndrome 122
Hepatic encephalopathy 110
acute fulminant hepatic failure 111
chronic liver disease 110
Herpes 100
Herpes encephalitis 101
Hypercalcemia 86
Hyperkalemia 117
Hyperosmolar non-ketotic diabetic coma 80
Hypertensive crisis 39
Hypertensive emergencies 121
Hyperuricaemia 121
Hypoglycemia 59
Hypokalemia 85
Hyponatremia 84
Hypotension 24
Hypovolemic shock 25
hemorrhagic 25
loss of plasma and fluids 25
Hypoxia 52, 59
I
Immunosuppressed patient 99
Instantaneous headaches 67
cluster headache 67
hypnic headaches 67
sex headaches 67
thunderclap headaches 67
Insulin 77
Intravenous aminophylline 50
Intravenous cannula 59
Intravenous catheter-related sepsis 103
L
Lactic acidosis 92, 165
Legionella 100
Leprosy reactions 163
types and management 163
Lung infection 99
LV failure 48
M
Major risk of aspiration 63
Malaria 158
Management of hypothermia 91
Metabolic acidosis 118
Methemoglobinemia 136
Migraine 70
Mild ketonuria 79
Mitral regurgitation 33
Mouth-to-mouth breathing 4
Multiple myeloma 121
Mycobacteria 100
Mycoplasma 100
Myocardial infarction 32, 144
Myocarditis 17
Myoglobinuria 121
Myotoxic snake bites 153
Myotoxic snakes 153
N
Narcotics 59
Narrow complex tachycardia 19
hemodynamic stability 19
Neurodeficit 83
Neuroparolytics 151
Neurotoxins 151
NIPPV 55
Normal anion gap metabolic acidosis 93
O
Obstruction due to tongue and epiglottis 12
Obstructive shock 29
Oesophageal bleeding 108
Mallory-Weiss syndrome 108
oesophagitis 108
varices 108
Oxygenation 48
P
Paracetamol poisoning 136
Paranasal sinus infection 101
PEA 10
Phaeochromocytoma 40
Plasma sodium 83
Pneumocystis 100
Pneumonia 52
Poison information centres 145
Poisoning 29
Pre-exposure and post- exposure prophylaxis 156
Primary pneumothorax 44
Procainamide 142
Procoagulant 127
Prophylaxis against pneumonia 55
Prophylaxis of rabies 155
post-exposure 155
pre-exposure 155
Prothrombotic conditions 127
Proximal airway obstruction 13
Pseudomonas 54
Pulmonary embolism 46
Pulmonary oedema 47, 118, 144
Pulse oximeter 59
Pupils 5
Pyrexia 88, 157
Q
Quinine 158
R
Recovery position 3
Referred headaches 72
Rehydration 162
Renal failure 92
Respiratory muscles 151
Responsiveness 3
Resuscitation 5
Rhabdomyolysis 165
S
Secondary ABCD 10
Secondary pneumothorax 45
Sedatives 59
Septic shock 28
Septicemia 52
Serum calcium estimation 87
Serum creatinine 117
Severe ketonuria 79
Shock 24
divisions 24
adrenal insufficiency 24
anaphylactic 24
cardiogenic 24
drugs/poisoning 24
hypovolemia 24
obstruction to blood flow 24
septic 24
Sickle cell anemia 149
crises in sickle cell anemia 149
aplastic crisis 149
hemolytic crisis 149
megaloblastic crisis 149
sequestration crisis 149
vaso-occlusive crisis 149
Single breath count 151
Snake bite 150
Specific antibiotic therapy 161
Specific antidotes 135
Specific meningitis 98
Spondylosis 72
Spontaneous pneumothorax 43
Stable narrow complex tachycardias 18
junctional tachycardia 18
multifocal atrial tachycardia 18
Stable ventricular tachycardia 16
Steroids 163
Subendocardial infarction 31
Supraventricular tachyarrhythmias 144
Suspected deep venous thrombosis 127
Systemic complications of AMI 37
Systemic diseases 69, 71
‘flu’ like illness 71
CO poisoning 71
depression 71
hangover headaches 71
hypertension 71
post head injury α-tension headache 71
T
Temporal arteritis 71
Tetanus 160
Thiamine 17
Thrombolysis 34
indications 34
contraindications 34
Thyroid diseases 88
Thyrotoxic crisis 87, 89
Tongue depressor 13
Toxoplasmosis 101
True hyponatremia 83
Typhoid fever 161
U
Ubstable tachyarrhythmias 11
Ubstable tachycardia 11
Unilateral headaches 70
Unstable angina 31
Uremic encephalopathy 19
Uremic pericarditis 119
postrenal 119
prerenal 119
renal 119
V
Vaccines 156
sheep brain derived 156
tissue culture derived 156
Vasculotoxic snake bite 122, 152
acute renal failure 152
bleeding 152
hemolysis 152
Venous thromboembolism 128
Ventricular arrhythmias 144
Ventricular fibrillation 17
Ventricular tachycardia 17
W
Wet beriberi 17
WPW syndrome 20
A fib 20
AAVRT 20
OVART 20
×
Chapter Notes

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1Medical Emergencies for Examinations
2Medical Emergencies for Examinations
ANEIL MAANAY MB MD MRCP(UK) MRCP(I) DME Consultant in Acute Medicine and Care of Elderly Erne Hospital, Enniskillen, Northern Ireland, UK BT 74 6AY
3Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
EMCA House, 23/23B Ansari Road, Daryaganj
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Medical Emergencies for Examinations
© 2005, Aneil Maanay
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition : 2005
9788180614439
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd., A-14, Sector 60, Noida
4
To
All my teachers, consultants and
senior colleagues from
whom I learnt ABC of medicine
5PREFACE
Life is complicated!
The junior doctors and medical students are constantly struggling to get the right dose of knowledge needed to treat patients at a practical level and to pass the examinations.
There are many textbooks describing the details of diseases. There are also many books on clinical medicine. However, there is a scarcity of books on medical emergencies.
This book would provide a practical, down-to-earth assistance in handling medical emergencies. The book would also provide a comprehensive thinking on medical emergencies, even though it is not a complete textbook of medicine.
I would be happy if the book brings management of medical emergencies, to a reasonable standard.
I have to thank all my teachers and consultants who taught me. Dr Kelly deserves a special mention.
I greatly acknowledge the hard work of Ms Susan McGinnty and Ann-Marie Geoghegan for typing such a complicated text.
Thanks
Aneil Maanay
6EVERY CANDIDATE MUST READ THE FOLLOWING
Viva/voce is a part of most of the medical examinations.
The questions, which are asked in this part of examination, are usually standardized. The first question comprises of “Medical Emergency”. This question on medical emergency carries great potential to pass the examination. It carries a heavy weight in judging candidate's overall approach to medicine. If anyone fails to answer properly on medical emergency has a very meager chance of getting through the examination.
Many candidates are working successfully, in a competent manner, in their hospitals. However, answering in the viva is a different, game play, altogether.
It requires other personality skills like; organized thinking, verbal communication, proper introduction of the topic, conclusion of the topic and eye-to-eye contact, etc.
In this book, each medical emergency, which is asked in the examination, is dealt smartly. I assure you, that the medical emergency question (topics) has to be from this book!
The questions can be asked in various ways, but the core remains the same, e.g.
  1. A boy is admitted unconscious, with rapid breathing.
    His Urine showed 4+ ketones.
    How will you proceed?
    OR
  2. Known diabetic girl complained of vomiting, pyrexia and polyuria. She has rapid breathing. Her glucose is 28 mmol/L. Her urine revealed ketones in large amounts.
    What will you do?
In both these questions, the examiner wanted a core answer for diabetic ketoacidosis.
Some tips for answering in viva examination.
7
Do not sidetrack to a main core answer, e.g. if you are asked the management of myocardial infarction, then describe the management of uncomplicated infarction first. You can discuss the management at complications later on. Do not start with complications.
I will give oxygen to patient of LV failure, because there is hypoxia and the hypoxia is due to pulmonary oedema. The pulmonary oedema is due to LV failure. The contractility of LV is decreased. Hence, there is a backpressure of pulmonary veins. This causes exudation of fluid into alveoli. This activates reflexes which causes shortness of breath and…
Instead, say, “I will start 40% to 100% of oxygen to a patient with LV failure”.
It will be better if you record your answers on a tape recorder and listen to yourself later. This gives you an insight to where you go wrong.
I said, “Some Physicians do liver biopsy before starting methotrexate. Some do not do it. I will take my consultant's opinion on this issue before starting methotrexate”.
The natural reaction on your side is, “I don't know”. But, a smart candidate would answer in a very good manner, such as:
For topics on ethical issues: Always look out in the mass media 6 months before the examination.
“I will categorize shock into 7 types”. Then, you are expected to enumerate all the 7 types. Otherwise it may not create a good impression. Rather, simply say, “I will divide shock into many categories like anaphylactic, septic, cardiogenic, hypovolemic etc”.
 
THE EXAMINATION SCHEME
You will be definitely successful, at some stage; if you follow these simple rules and the scheme in this book.
Best of luck!
Aneil Maanay
10Abbreviations AAVRT:
Antidromic atrioventricular re-entry tachycardia
ABC:
Airway, breathing and circulation
ABG:
Arterial blood gas
A fib:
Atrial fibrillation
AICD:
Automatic implantible cardioverter and defibrillator
AMI:
Acute myocardial infarction
APTT:
Activated partial thromboplastin time
ARDS:
Adult respiratory distress syndrome
ARF:
Acute renal failure
AVNRT:
Atrioventricular nodal re-entry tachycardia
BiPAP:
Bilevel positive airway pressure
BP:
Blood pressure
CABG:
Coronary artery bypass graft
CCF:
Congestive cardiac failure
CCU:
Coronary care unit
CHF:
Congestive heart failure
CMV:
Cytomegalovirus
CNS:
Central nervous system
CO:
Carbon monoxide
COPD/COAD:
Chronic obstructive pulmonary/ airways disease
CPAP:
Continuous positive airway pressure
CPK:
Creatinine phosphokinase
CPR:
Cardiopulmonary resuscitation
CT:
Computerized tomography
CVA:
Cerebrovascular accident
CVP:
Central venous pressure
DC:
Direct current
DIC:
Disseminated intravascular coagulation
DKA:
Diabetic ketoacidosis
ECG:
Electrocardiograph
EMD:
Electromechanical dissociation
ESR:
Erythrocyte sedimentation rate
EST:
Exercise stress test
FBC:
Full blood count
FiO2:
Fraction of inspired oxygen
GCS:
Glasgow coma scale
GIT:
Gastrointestinal tract
GP:
General practitioner
GUT:
Genitourinary tract
HD:
Hemodialysis
HDU:
High dependency unit
Hib:
Haemophilus influenzae b11
HIV:
Human immunodeficiency virus
HT:
Hypertension
ICD:
Intercostal drainage
ICU:
Intensive care unit
IHD:
Ischaemic heart disease
IM:
Intramuscularly
INH:
Isoniazid
INR:
International normalized ratio
ITU:
Intensive therapy/thoracic unit
IV:
Intravenous
JVP:
Jugular venous pressure
KCL:
Potassium chloride
LA:
Left atrium
LBBB:
Left bundle branch block
LDH:
Lactose dehydrogenase
LFT:
Liver function tests
LP:
Lumbar puncture
LV:
Left ventricle
LVEF:
Left ventricular ejection fraction
LVF:
Left ventricular failure
MAO:
Mono amino oxidase
MAT:
Multifocal atrial ectopic tachycardia
MCGN:
Mesangiocapillary glomerulonephritis
MELAS:
Mitochondrial encephalopathy lactic acidosis and strokes
MRI:
Magnetic resonance imaging
MRSA:
Methicillin resistant Staphylococcus aureus
Ms:
Milliseconds, mitral stenosis, multiple sclerosis
MSU:
Midstream urine
NAC:
N-acetyl cysteine
NaHCO3:
Sodium bicarbonate
NB:
Nota bene
NG:
Nasogastric tube
NIPPV:
Non-invasive positive pressure ventilation
NSAIDs:
Non-steroidal anti-inflammatory drugs
OAVRT:
Orthodromic atrioventricular re-entry tachycardia
OP:
Organophosphates
PAT:
Paroxysmal atrial tachycardia
PCP:
Pneumocystis carinii pneumonia
PCR:
Polymerase chain reaction
PCWP:
Pulmonary capillary wedge pressure
PE:
Pulmonary embolism
PEA:
Pulseless electrical activity
PEFR:
Peak expiratory flow rate
PFA:
Plain film of abdomen
PO:
Per oral
PR:
Per rectal examination12
PRN:
Pro rata
PSVT:
Paroxysmal supraventricular tachycardia
PT:
Prothrombin time
PTH:
Parathormone
qid/qds:
Four times a day
RBBB:
Right bundle branch blocks
RFT:
Renal function tests
RIG:
Rabies immunoglobulin
RTA:
Renal tubular acidosis
rt-pa:
Recombinant tissue plasminogen activator
SAH:
Sub arachnoid haemorrhage
SC:
Subcutaneous
SIADH:
Syndrome of inappropriate secretion of antidiuretic hormone
SOL:
Space occupying lesion
SPO2:
Saturation of haemoglobin with O2
SSRIS
Selective serotonin reuptake inhibitors
SVT:
Supraventricular tachycardia
T3:
Triiodo thyronine
T4:
Thyroxine hormone
TB:
Tuberculosis
TDD:
Total daily dose
tDS/tID:
Three times a day
TFT:
Thyroid function tests
TIA:
Transient ischaemic attack
TOE:
Transoesophageal echocardiography.
TPA:
Tissue plasminogen activator
TSH:
Thyroid stimulating hormone
TT:
Tetanus toxoid, tuberculin test
U&E:
Urea and electrolytes
USG:
Ultrasonography
UTI:
Urinary tract infection
V. fib:
Ventricular fibrillation
V/Q:
Ventilation/perfusion scan
VP:
Ventriculoperitoneal
VT:
Ventricular tachycardia
WHO:
World health organisation
Wt:
Weight
XRC:
Chest radiograph
ZN:
Ziehl-neelsen stain13
14Conversion Factors for mmol/L and mg%
Blood Urea
(mg%) × 0.055 = mmol/L
Serum Creatinine
(mg%) × 88.4 = micromol/L
Blood Glucose Level
(mg%) × 0.0555 = mmol/L
Blood PCO2
(mm of Hg) × 0.13 = kPa
Blood PO2
(mm of Hg) × 0.13 = kPa
Serum Bilirubin
(mg%) × 17 = micromol/L
Serum Calcium (Total)
(mg%) × 0.25 = mmol/L