UK Medical Licensing Assessment (UKMLA) Acute and Emergency Medicine Flashcards

24 sample cards from the Acute and Emergency Medicine deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. At what GCS is definitive airway protection (intubation) generally indicated, and why?

   GCS $\leq 8$, because of loss of protective airway reflexes and high aspiration risk ('GCS 8, intubate').

2. What reversible causes should be actively excluded in a patient with reduced consciousness or coma?

   Hypoglycaemia (check capillary glucose), opioid toxicity (give naloxone), hypoxia/hypercapnia, hypothermia, hyponatraemia/metabolic derangement, seizure/post-ictal state, intracranial haemorrhage/mass, and infection (meningitis/encephalitis).

3. What clinical features distinguish true cardiac/arrhythmic syncope from a benign vasovagal faint?

   Red-flag (cardiac) features: syncope on exertion or while supine, no/short prodrome, associated palpitations or chest pain, family history of sudden death, and abnormal ECG. Vasovagal: clear trigger, prodrome (nausea, sweating, visual greying), upright posture, and rapid full recovery.

4. What are the key examination and ECG checks in a patient presenting after collapse/syncope?

   Lying and standing BP (postural drop $\geq 20$ mmHg systolic), 12-lead ECG looking for long QT, Brugada, heart block, WPW, ischaemia or arrhythmia; plus cardiac auscultation for outflow murmurs (e.g. aortic stenosis, HOCM).

5. What is a thunderclap headache and what is the most important diagnosis to exclude?

   A severe headache reaching maximum intensity within $1$ minute (often described as 'worst ever'). Subarachnoid haemorrhage (SAH) must be excluded as the priority.

6. What is the recommended investigation pathway for suspected subarachnoid haemorrhage?

   Urgent non-contrast CT head (most sensitive within 6 hours of onset). If CT is negative but suspicion remains and onset was $>6$ h ago, perform lumbar puncture at $\geq 12$ h looking for xanthochromia.

7. Outline the general 'TOXBASE' approach to the poisoned patient.

   Resuscitate using ABCDE first, then identify the toxin (history, examination, toxidromes), consult TOXBASE/poisons centre, consider decontamination (e.g. activated charcoal if within 1 h), give specific antidotes, and enhance elimination where indicated.

8. Match these poisons to their specific antidotes: paracetamol, opioids, benzodiazepines, beta-blockers, organophosphates, iron.

   Paracetamol → N-acetylcysteine; opioids → naloxone; benzodiazepines → flumazenil (rarely used); beta-blockers → glucagon; organophosphates → atropine ($\pm$ pralidoxime); iron → desferrioxamine.

9. How is the decision to treat paracetamol overdose with N-acetylcysteine made?

   Plot the serum paracetamol level (taken $\geq 4$ h post-ingestion) on the treatment nomogram; treat if on/above the line. Treat regardless of level if staggered overdose, unknown timing, or already $>8$ h since ingestion.

10. Describe the management priorities for severe accidental hypothermia.

    Handle gently (risk of arrhythmia), use active rewarming (warmed IV fluids, warm humidified $\ce{O2}$, forced-air blankets, or extracorporeal rewarming if cardiac arrest), and prolong resuscitation because 'no one is dead until warm and dead' – do not stop CPR until core temperature $>32$–$35^{\circ}\mathrm{C}$.

11. What are the features and management of severe anaphylaxis?

    Acute onset of Airway/Breathing/Circulation compromise with skin/mucosal changes after exposure. Treatment: IM adrenaline $500$ \mu g ($0.5$ mL of $1{:}1000$) into the anterolateral thigh, repeated every $5$ min; plus high-flow $\ce{O2}$, IV fluids, and lay flat with legs raised.

12. What scoring tool assesses alcohol withdrawal severity, and what is the first-line drug treatment?

    The CIWA-Ar score assesses withdrawal severity. First-line treatment is a benzodiazepine (e.g. chlordiazepoxide or diazepam), often given as a reducing regimen or symptom-triggered.

13. What is the triad of Wernicke's encephalopathy and how is it prevented/treated in alcohol-related emergencies?

    Triad: confusion, ophthalmoplegia/nystagmus, and ataxia. Prevent/treat with parenteral thiamine (e.g. IV Pabrinex) given before any glucose, as glucose can precipitate Wernicke's in thiamine-deficient patients.

14. In ATLS, what does the primary survey assess and in what sequence?

    Catastrophic haemorrhage control then ABCDE: A – Airway with cervical-spine protection, B – Breathing, C – Circulation with haemorrhage control, D – Disability, E – Exposure/environment. Often written as <C>ABCDE.

15. How does the secondary survey in trauma differ from the primary survey?

    The secondary survey is a head-to-toe examination plus a full AMPLE history (Allergies, Medications, Past history, Last meal, Events), performed only once the primary survey is complete and the patient is stabilised, to detect all other injuries.

16. List the Canadian CT Head Rule high-risk criteria indicating a CT head within 1 hour after head injury (NICE).

    GCS $<13$ on initial assessment or $<15$ at 2 h, suspected open/depressed or basal skull fracture, post-traumatic seizure, focal neurological deficit, or $>1$ episode of vomiting.

17. What clinical signs suggest a basal skull fracture?

    Periorbital ('panda/raccoon') eyes, Battle's sign (mastoid bruising), CSF rhinorrhoea or otorrhoea, and haemotympanum.

18. What is the lethal triad of trauma that worsens haemorrhage outcomes?

    Hypothermia, acidosis, and coagulopathy – a self-perpetuating cycle that must be interrupted by damage-control resuscitation and rapid haemorrhage control.

19. What is 'permissive hypotension' in trauma resuscitation and what blood product strategy accompanies it before surgical haemorrhage control?

    Deliberately keeping blood pressure low (e.g. systolic $\sim 80$–$90$ mmHg, or a palpable radial pulse) to avoid dislodging clot, while using a balanced 1:1:1 ratio of packed red cells, plasma and platelets and giving tranexamic acid early.

20. What is the role and timing of tranexamic acid (TXA) in major trauma haemorrhage?

    TXA (an antifibrinolytic) reduces mortality from bleeding when given early – ideally within 3 hours of injury (loading $1$ g over 10 min, then $1$ g over 8 h); benefit is lost and harm possible if given $>3$ h after injury.

21. Define a tension pneumothorax versus an open ('sucking') chest wound and give the immediate management of each.

    Tension pneumothorax: one-way air accumulation causing mediastinal shift and obstructive shock → needle decompression then chest drain. Open chest wound: air drawn through a chest wall defect → three-sided occlusive dressing then chest drain.

22. What is Beck's triad and which condition does it indicate?

    Beck's triad = hypotension, raised JVP/distended neck veins, and muffled heart sounds. It indicates cardiac tamponade, managed by pericardiocentesis or thoracotomy.

23. What is the START triage system and its four colour categories?

    START (Simple Triage And Rapid Treatment) sorts mass-casualty patients by ability to walk, respirations, perfusion and mental status into: Green (minor/walking), Yellow (delayed), Red (immediate), and Black (deceased/expectant).

24. What does the major-incident mnemonic CSCATTT stand for?

    Command and control, Safety, Communication, Assessment, Triage, Treatment, Transport – the structured framework for managing a major incident.

What this deck covers

Acute and Emergency Medicine flashcards FAQ