22/5

Question 1

How to reverse local anaesthetic toxicity?

Answer 1

20% intralipid infusion - binds to anaesthetic

Question 2

What antibiotics can put you at increased risk of achilles tendon rupture?

Answer 2

Ciprofloxacin

Question 3

What surgery is used in pts with persistent symptomatic hiatus hernias?

Answer 3

Nissen’s fundoplication
- corrects the defect by tightening the crura and wrapping gasrtic fundus around the LOS

Question 4

What antibodies are associated with anti-phospholipid syndrome?

Answer 4

Anti-cardiolipid
Anti-B2-GPI
+ve lupus anticogulant assay

Question 5

What meds are prescribed in ACP?

From 10mg of oral morphine what is the conversion to codiene, IM/IV morphine, oral oxy, IV/IM oxy?

What is breakthrough?

What pain medication is preferred in renal impairment?

Answer 5

Hy Mi LeMO

Hyoscine (reduce viscosity of secretions)
Midazolam (distress)
Levomepromazine (nausea)
Morphine (pain)

+ often a laxtative (often Senna)

1/6th of daily morphine dose (if used for than 3x a day up the maintance dose by 30%)

Oxycodone preferred in renal impairment as metabolised hepatically

Codeine x10 = 100mg
IV/IM morphine /2 = 5mg
oral oxy /2 = 5mg
IM/IV oxy /4 = 2.5mg

Question 6

Falls Hx
Management of falls

What meds put you at increased risk of orthostatic hypotension?

Answer 6

What, where and how?
Split into before, during and after
Before
- any dizziness, syncope
- events before

During
- any trauma esp. head
- LOC?

After
- how did you get up?
- how long were you lying?
- fallen before?
- fear of falling

Systemic enquiry
- head - headaches, vision changes, dizziness in general
- heart and lungs = SOB, palpitations, chest pain, swollen ankles
- legs = peripheral neuropathy, oedema
infection = how been in self recently, bowel and bladder, eating and drinking

Everything else, social Hx for house is v important

Management
MDT approach - GP, PT, OT, optician

Conservative
PT - strength and balance training
OT - falls assessment of the home and can fit community alarm
Optician - visual assessment
Make sure drinking enough and take it slow around the house

Medical
Meds that can cause hypotension
- Anti-HTN, alpha blockers e.g. tamsulosin, doxazosin, antidepressants/psychotics, insulin

Question 7

Different hand position for thrills and heaves?

Answer 7

Heaves = just twice vertically on either side of the sternum

Thrills = palpable murmur = horizontally across all 4 regions of the heart

Question 8

Define orthostatic hypotension

Answer 8

Drop of 20mmHg or more - systolic
Drop of 10mmHg or more - diastolic

Question 9

How would you describe to a pt to take a FIT test?

Answer 9

Get a plastic container and line with toilet roll, put into toilet and poo into that as normal. DO NOT wee in it and don’t let it touch the water.

Then collect the stool sample using the stuff provided

Question 10

Change in bowel habit - what systemic enquiry is important

Answer 10

Autoimmune - skin/joint/eye changes

Anaemia?
- palps
- SOB
- lethargy?
- dizziness/headaches

Question 11

Protocol now changed for 2-week urgent colonscopy for bowel cancer. Now do a FIT test first. who do you offer that to? What must the result be to send them for 2 week urgent colonscopy?

Answer 11

• abdo mass
• change in bowel habit
• Fe+ anaemia
• > 40 w/ weight loss and abdo pain
• <50 w/rectal bleeding AND weight loss or abdo pain
• > 50 yo w/rectal bleeding OR weight loss OR abdo pain
  60 yo w/ ANY anaemia

> /= 10 Hb/gram of faeces = 2 week urgent colonscopy

Question 12

What would be seen on electron microscopy in post-strep GN?

Answer 12

Subepithelial humps