30/11

Question 1

What is used to control AF?

When is a DOAC started after stroke?

Answer 1

Rate
1. Beta-blocker
2. Rate-limiting CCB - verampil
3. Digoxin

Rhythm (mostly done in hospital)
- Electrical = DCCV
- Chemical = amoidarone

Wait at least 2 weeks to start a DOAC to reduce risk of haemorraghic stroke

Question 2

What are the side effects of anti-cholingeric medications?

Give some examples of medications.

What are their indications

Answer 2

Anti-cholingeric - prevent the action of the parasympathetic system (increased sympathetic drive)

General - hyperthermia and can’t sweat

GI - CONSTIPATION and vomiting

Cardio - tachycardia, flush and arrythmias

GU - urinary RETENTION

Oxybutynin - urge incontience and detrusor hyperactivity

Benzotropine - reduces dopamine levels and improves symptoms in PD

Question 3

Claudication of the lower legs settled with rest and on leaning forward (walking up hill or cycling)

Answer 3

Lumbar spinal stenosis

Question 4

What are the most common causes of bowel obstruction?
As a result what questions do you need to ask in the history?

How do you manage these patients?

Answer 4

• Adhesions
• Hernias
• Malignancy

Any previous abdominal surgery?
Any hernias
Any weight loss, PR bleeds or change in bowel habit?

1. ABCDE
2. “Drip and suck”
   - Nil by mouth
   - IV fluids
   - NG tube

Question 5

What can cause DIC?

What are the blood findings?

What happens to platelets?

Answer 5

Delivery - obstetric delivery
Infection/immunological - sepsis
Cancer

Raised APTT and PT due to reduced circulating clotting factors (being used up making clots)
Raised D-dimer - clots being broken down
Increased fibrin - making clots

REDUCED PLATLETES - THROMBOCYTOPENIA