4. Planning Management

Question 1

How do you manage fever?

Answer 1

Treat cause
Paracetamol

Question 2

What kind of laxatives are the following…
Docusate
Isphagula husk
Lactulose
Senna+ Bisacodyl

Answer 2

Docusate: Stool softener
Isphagula husk: bulking agents
Lactulose: osmotic laxative
Senna+ Bisacodyl: stimulant

Question 3

What laxatives should be avoided in acute abdomen?

Answer 3

Stimulants and osmotics

Question 4

What laxatives are good for faecal impaction?

Answer 4

Docusate (stool softener)

Question 5

What can you give for diarrhoea?

Answer 5

Exclude infective causes
Give loperamide 2mg OR codeine 30mg

Question 6

How do you manage…
STEMI
NSTEMI
Acute LVF

Answer 6

Question 7

How do you manage a tachy that is unstable?

Answer 7

Question 8

How do you manage a tachy that is stable and broad?

Answer 8

Question 9

How do you manage a tachy that is stable and narrow?

Answer 9

Question 10

How do you manage anaphylaxis?

Answer 10

Question 11

How do you manage an acute asthma exacerbation?

Answer 11

Question 12

How do you manage a pneumothorax?

Answer 12

tension: emergency aspiration + chest drain
Secondary: aspiration + chest drain (if >2cm/SOB/>50 years)

Question 13

How do you manage an acute pneumonia?

Answer 13

Question 14

How do you manage an acute PE?

Answer 14

Question 15

How do you manage an acute GI bleed

Answer 15

Question 16

How do you manage bacterial meningitis?

Answer 16

Question 17

How do you manage a seizure?

Answer 17

Question 18

How do you manage a stroke?

Answer 18

Question 19

How do you distinguish between DKA and HONK?
How do you manage both cases of hyperglycaemia?

Answer 19

DKA // HONK
Ketones present // absent
raised pH // osmolality over 340mmol/L (2(Na+K) + urea + glucose)

Question 20

How to manage hypoglycaemia?

Answer 20

Oral intake: sugary drink or biscuit
No oral but IV: 100ml 20% glucose
No oral or IV: IM glucagon 1mg

Question 21

How do you diagnose an AKI?

Answer 21

Question 22

How do you manage an AKI?

Answer 22

Question 23

When do you treat hypertension?
What are the target values?

Answer 23

If BP >150/95mmHg OR
If >135/85 + the following:
- Q-risk >10% or existing CV disease
- End organ damage
–> Under 80: 135/85 ABPM or 140/90mmHg
–> over 80: +10 to above systolic values

Question 24

How do you treat HTN?

Answer 24

Question 25

When is rhythm control given first in AF

Answer 25

If the AF is... Reversible Onset < 48 hours Causing HF Symptomatic on rate

Question 26

Outline rhythm control in AF

Answer 26

Initial <48 hours/unstable: Cardioversion Pharmacological: flecainide/amiodarone Electrical: Defibrillation Long-term 1. B-blockers 2. Dronendarone if successful DC 3. Amiodarone if HF/LVD

Question 27

Outline rate control in AF

Answer 27

1. Atenolol 50-100mg daily 2. CCB if no heart failure 3. Digoxin if sedentary

Question 28

How is stroke management determined in AF?

Answer 28

Congestive HF HTN Age > 75 Diabetes Stroke/TIA Vascular disease Age 65-74 Sex (female)

Question 29

If CHADSVAS >=1 what is given for AF?

Answer 29

NOACs Warfarin if NOACs dont work

Question 30

How do you manage Diabetes mellitus?

Answer 30

T1DM: Insulin T2DM: 1. Metformin 500mg 2. + gliptin/sulfonylurea/SGLT-2I/pioglitazone 3. + another of above drugs 4. Metformin + sulfonylurea + GLP-1 mimetic

Question 31

COPD management?

Answer 31

Question 32

What are the typical first line treatments for Parkinson's disease?

Answer 32

Typically co-beneldopa/carledopa mild + concerned about levodopa: DA or MAO-I

Question 33

Outline the management for the following seizures... Generalised tonic-clonic Absence seizures Myoclonic Tonic Focal

Answer 33

Sodium valproate apart from Absence: can use ethosuximide Focal: Carbamazepine or lamotrigene

Question 34

What are the side effects of... Lamotrigene Carbamazepine Phenytoin Sodium valproate

Answer 34

Lamotrigene: Rash, SJS Carbamazepine: Rash, cerebellar, low Na Phenytoin: Cerebellar, neuropathy, liver damage Sodium valproate: Tubby, tremor, teratogenic

Question 35

How to distinguish between Crohn's and UC

Answer 35

Crohn's // UC RIF mass // LIF pain Anywhere // recto-caecal Deep, skipping ulcers // continuous ulcers Gallstones // PSC Granulomatous // crypt abscesses

Question 36

What is the induction regime for Crohn's

Answer 36

1. Steroids 2. 5-ASA +azathioprine/mercaptopurine Consider biologics if > 5 days without improvement

Question 37

What is the induction regime for UC?

Answer 37

Mild-moderate flare (4-6 stools) 1. Topical 5-ASA + oral 5-ASA/steroid if proctitis Severe IV steroids + ciclosporin if no improvement

Question 38

What are the maintenance options for Crohn's and UC

Answer 38

Crohn's Stop smoking 1st line: Azathioprine/mercaptopurine UC Mild-mod: topical 5-ASA/oral/both Severe: Azathioprine/mercaptopurine