ACC

Question 1

Causes for upper GI bleeds

Answer 1

Varices
Malory wise tear
Peptic ulcer perforation

Question 2

Management of Ulcer diagnosed by endoscopy in upper GI bleed

Answer 2

Omeprazole 80mg IV, then 8mg/hr for 48hrs

Question 3

Management of variceal bleed

Answer 3

Abx prophylaxis

Terlipressin

Question 4

How is hypovolaemic shock classified and what is this score based on?

Answer 4

% Blood loss
Heart rate 
ventilation rate 
systolic BP
Urine output

Question 5

Which fluids should be used in haemorrhage, and which should not (why?)

Answer 5

Use crystalloid - saline, hartmans, plasmalyte

Don’t use colloid, as this can precipitate HF and oedema

Question 6

How much should one unit of packed red cells raise the Hb by?

Answer 6

10g/L

Question 7

Patient being managed in resuscitations for major GI bleed. You then notice blood oozing from cannula sites.

1) What is the diagnosis
2) How else may this present
3) How do you manage this patient, what is the cut off for a platelet transfusion
4) If the patient was fluid overloaded what would be an alt management

Answer 7

1) DIC
2) Peticial rash (microvascular bleeding)

3) FFP, pmts < 50 = transfuse
Severealy depleted clotting factors = cryoprecipitate

4) Prothrombin complex concentrate

Question 8

Definition of major haemorrhage x 3

Answer 8

1 One whole blood volume lost in 24hrs (70mL/kg)
2 50% of blood volume in 3 hours
3 150mL/minute

Question 9

Emergency warfarin reversal

Answer 9

Prothrombin complex concentrate

Question 10

Emergency rivaroxibam reversal

Answer 10

andexant alpha

Question 11

GCS - eye, movement, voice responses

Answer 11

cba to write this all down. Check somewhere else

Question 12

Causes of low GCS

Answer 12

HYPO
Post seizure 
Drugs - overdose 
Hypoxia
Myoedema coma 
Addisons crisis 
infection (sepsis). 
Vascular (stroke etc)

Question 13

Causes of hypoglycaemia (don’t say diabetes you plum)

Answer 13

Insulin/sulfonylureas 
Quinolones, ACEI, b blockers, alcohol 
Sepsis
renal impairment 
Low cortisol 
paraneoplastic syndrome 
insulinomas

Question 14

Mechanism of action of

1) Depolarizing muscle relaxants
2) Non-depolarizing muscle relaxants

Answer 14

1) Bind to Ach receptors, cause muscle contraction and then paralysis (Ach receptor agonist)
2) Bind to and block Ach receptors (Ach competitive inhibitor)

Question 15

2 drugs used in paracetamol poisoning and the timings of both drugs first dose.

Answer 15

Activated charcoal (given within the first hour of overdose)

n -Acetylcysteine. 150mg/kg over 15-60min.

Question 16

Dosages and timings for n-acetylcysteine

Answer 16

150mg/kg over 15min
50mg/kg in 500mL over 4hrs
100mg/kg in 1L over 16hrs

Question 17

Hyperkalaemia mx

Indications to treat

3 Drugs used and dosages/infusions

Answer 17

6 < K+ < 6.5 = Do an ECG, treat if changes.
k+ > 6.5 = Treat immediately.

10mL 10% calcium chloride or 30mL 10% Calcium gloconate to protect heart.
IV over 5-10 min

IV 10U of insulin in 25g glucose. To move k+ into cells.

Nebulised Salbutamol 10-25mg. (Lower dose if IHD)

Question 18

alternative to n-acetylcysteine

Answer 18

Methionine 2.5g every 4hrs for 16 hours. PO