Conference Quiz

Which one of the following broad group of triggers of anaphylaxis is most likely to cause breathing difficulties leading to cardiac arrest?

Which of the following symptoms is most commonly present in patients with a pulmonary embolism in the ED?

A 50-year-old woman is awaiting transfer to the regional cardiothoracic surgical centre with a Type A aortic dissection. Her blood pressure continues to be elevated at 180/110 despite opiate analgesia. She has a previous history of hypertension, but is otherwise fit and well normally.

Which one of the following antihypertensives would be the best to use for her?

Which two clinical indicators suggest that a patient with frailty may be approaching the end of life?

A 26-year-old motorcyclist has presented to your emergency department having been hit by a car. His airway is patent, and his spine immobilised. On chest examination, you detect RR 26, sats 94% on high-flow oxygen, crepitus suggesting rib fractures to his upper left side anteriorly, reduced breath sounds left side, resonance possibly increased left side. He has P 120 SR and BP 110/70.

Regarding his chest injury management, which of the following is the most appropriate next move?

A 38-year-old lady presents to the ED. She has had recurrent headaches for years, but these are much worse in the last 7 days and are now virtually constant. Despite regular analgesia, she is finding it difficult to cope at home and a work.

Which one of the following would most support a diagnosis of tension-type headache?

In which area of the brain is a stroke most likely to cause equal, marked weakness of the left face, arm and leg?

A 65-year-old patient presents with difficulty in breathing and a cough. The patient has had a dry cough for a week and a mild fever. He has had episodes of chest pain on-and-off for a month. He has a background of hypertension and dyslipidaemia.

His initial observations are respiratory rate 20, heart rate 120, blood pressure 75/40 and temperature of 37.8o C. His chest x-ray shows upper lobe diversion. POCUS shows:

Case courtesy of Dr David Carroll, Radiopaedia.org

How would you manage this patient?

A 33-year-old male comes to the department in an intoxicated state. He reports suicidal ideation and has taken an overdose of paracetamol. He lives alone and is unemployed. He regularly drinks 2 litres of cider a day. Paracetamol levels come back as below the treatment line at 4 hours.

How would you manage this patient?

Which of the following would suggest a diagnosis of necrotising fasciitis rather than uncomplicated cellulitis?

Lucy falls over on the outstretched hand sustaining a hyperflexion injury to the distal radius of her left wrist. She is aged 7 years. X-ray confirms a distal radial buckle fracture with significant dorsal deformity but no distal angulation. The ulna is not involved.

Regarding further management:

What would be the first step in a 16-year-old having acute anaphylactic reaction on peanut ingestion?

You see a patient in the ED who you strongly suspect has Brugada Syndrome. His ECG does not show ST segment elevation.

Which one of these statements is True?

Which of the following might serve as the best modification of the standard advanced life support (ALS) protocol for beta-blocked patients in anaphylactic-induced cardiac arrest?

A 60-year-old patient presents with severe difficulty in breathing. He has a background of COPD, bullous disease and left upper lobe lobectomy. 

His initial observations are respiratory rate of 32, SpO2 of 82% on 15L NRB, heart rate of 140, and blood pressure of 80/50. He has reduced air entry bilaterally. His initial arterial blood gas shows pH 7.1, pO2 8, pCO2 9 and lactate of 5.

You are not sure whether his chest x-ray shows a bulla or pneumothorax. POCUS shows normal cardiac views. The lung views show:

Image courtesy of Dr. Stenberg thepocusatlas.com

How would you manage this patient?