I85PREP
⌘ K
MRCPI GM Part II Written study materials
MRCPI GM Part II Written study resources

MRCPI GM Part II Written: Acute and emergency medicine, including critical care

MRCPI GM Part II Written · Work through your exam, one topic at a time.

All guide sections

Acute and emergency medicine, including critical care

This domain rewards a reproducible first ten minutes: ABCDE, a differential for shock, and a defined treatment bundle.

Sepsis and shock

Sepsis-3 means infection plus organ dysfunction (SOFA ≥2); qSOFA is a prompt, not a diagnosis. Take cultures, measure lactate, give broad-spectrum antibiotics within one hour in septic shock, give 30 mL/kg crystalloid for hypotension or lactate ≥4, then start noradrenaline targeting MAP ≥65 mmHg. Source control is part of the resuscitation.

Shock classification

  • Cardiogenic: cold, raised JVP, crackles.
  • Obstructive: PE, tamponade, tension pneumothorax.
  • Distributive: warm, low systemic vascular resistance.
  • Hypovolaemic: dry, flat JVP. Bedside echocardiography and lactate refine the picture.

Resuscitation

VF and pulseless VT need immediate defibrillation, with adrenaline after the third shock; non-shockable rhythms need adrenaline 1 mg every 3–5 minutes plus treatment of reversible causes. Anaphylaxis: intramuscular adrenaline 0.5 mg (1:1000) into the anterolateral thigh, repeated at five minutes, with fluids and trigger removal.

Metabolic emergencies

DKA: 0.9% saline, fixed-rate insulin 0.1 units/kg/h, 10% glucose once glucose falls below 14 mmol/L, potassium replacement, and insulin continued until ketones clear. Hyperkalaemia with ECG change: calcium gluconate first, then insulin–dextrose and salbutamol, with dialysis if refractory.

Worked example

A 22-year-old presents with glucose 28 mmol/L, pH 7.05, bicarbonate 6 mmol/L, ketones 5.8 mmol/L and potassium 5.6 mmol/L. Reasoning: severe DKA, and potassium will fall sharply once insulin starts. Give saline, start fixed-rate insulin, check potassium hourly, add glucose when it falls below 14, and do not give bicarbonate at pH 7.05.

Traps

  • Stopping insulin when the glucose normalises instead of when ketones clear.
  • Forgetting potassium replacement during DKA.
  • Treating presumed sepsis without cultures.
  • Giving anaphylaxis adrenaline into the deltoid.
  • Flooding a cardiogenic shock patient with crystalloid.