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PSA > chapter 4 > Flashcards

chapter 4 Flashcards

1
Q

mx of a STEMI?

A 
aspirin 300mg
Morphine 5–
10mg IV with
metoclopramide
10 mg IV
Primary PCI
(preferred) or
thrombolysis
β-blocker
e.g. atenolol 5 mg oral
(unless
LVF/asthma)
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2
Q

what do you do insteadof PCI for NSTEMI?

A

aspirin 300mg

fondaparinux 2.5mg if they do not have a high bleeding risk/ arent going to cath lab

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3
Q

Mx of acute HF?

A

Furosemide

40–80 mg IV

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4
Q

What adverse features would make you deliver a DC shock in adults with tachycardia?

A

shock
acute HF
syncope
MI

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5
Q

What are the differentials and mx for broad complex irregular tachycardia?

A

AF + BBB –> same treatment as narrow complex
Polymorphic VT –>
(e.g. torsade de pointes -
give magnesium 2 g over 10 m

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6
Q

What are the differentials and mx for broad complex regular tachycardia?

A

VT –> Amiodarone 300 mg IV over 20–60 min; then 900 mg over 24 h
If previously confirmed SVT with BBB –> adenosine as for regular narrow complex tachycardias

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7
Q

What is the mx for narrow complex regular tachycardia? e.g. SVT

A

vagal manoeuvres

Adenosine 6 mg rapid IV bolus;
if unsuccessful give 12 mg;
if unsuccessful give further 12 mg

if atrial flutter get expert gelp

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8
Q

What is the mx for narrow complex irregular tachycardia?

A 
Probable atrial fibrillation
Control rate with:
β-blocker or diltiazem
Consider digoxin or amiodarone
 if evidence of heart failure
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9
Q

mx for anaphylaxis?

A 
ABCDE
remove cause
adrenaline 500 mcg 1:1000 IM
clorphenamine 10mg IV
hydrocortisone 200mg IV
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10
Q

mx of acute asthma?

A

100% O2 by nonrebreather mask

Salbutamol
(5 mg NEB)

Hydrocortisone 100 mg
IV (if severe/life threatening)
or prednisolone
40–50mg oral (if moderate)

Ipratropium (500
micrograms NEB)

Theophylline (only
if life threatening)

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11
Q

mx for secondary Pneumothorax?

A

(i.e. patient has lung disease) then always needs
treatment: chest drain if >2 cm or patient SOB or if >50 years
old; otherwise aspirate.

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12
Q

mx for tension Pneumothorax?

A

(i.e. clinical distinction but often
tracheal deviation +/− shock) then emergency aspiration
required, but will need chest drain quickly.

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13
Q

mx for primary Pneumothorax?

A

` if <2 cm rim and not SOB then discharge with outpatient
follow-up in 4 weeks.
` if >2 cm rim on CXR or feels SOB then aspirate and if
unsuccessful aspirate again, and if still unsuccessful then
chest drain.

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14
Q

mx for PE?

A

Morphine 5–10 mg IV,

metoclopramide 10 mg IV

Give LMWH before CTPA but once confirmed do a
DOAC e.g. rivoraxiban 15mg BD

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15
Q

mx for GI bleeding?

A

x 2 cannula large bore
Cross match 6 units blood
Endoscopy
Stop antiplatelets/ coagulants
Check for clotting abnromalities: If PT/aPTT more than 1.5 normal range ⇒ give fresh frozen plasma (unless due to warfarin ⇒ give prothrombin complex (e.g.
Beriplex®)); if platelets <50 × 109
/L (and actively bleeding) give platelet transfusion.

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16
Q

mx of meningitis?

A

LP +/- CT head (dont want to delay LP)
IV dexa
2 g cefotaxime IV (give pre-LP if having CT head or prolonged LP)

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17
Q

mx of seizures?

A

Patent airway
Recovery position
check glucose, electrolytes, drugs, sepsis that could be provoking

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18
Q

mx of status epillepticus (> 5 mins)?

A

10mg buccal midazolam
IV lorazepam 4mg, repeated after 10 minutes up to 3 doses if the seizure continues
Get anaesthatist
If seizures persist: IV phenobarbital or phenytoin
Intubate

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19
Q

mx for a stroke?

A

CT to check for haemorrhage
If onset <4.5 hours ago consider thrombolysis with alteplase
Aspirin 300mg stat

20
Q

What is the criteria for DKA?

A

Diabetic (i.e. hyperglycaemia – BM often >30mmol/L)
Keto (i.e. check urine or blood ketone levels)
Acidosis (i.e. low pH on ABG).

Also watch out for increased potassium.

21
Q

What is the criteria for Hyperosmolar Hyperglycaemic State?

A

● Hyperglycaemia (usually >35mmol/L)
● HO (hyperosmolar: osmolality over 340mmol/L (calculated by
(x2 Na + x2 K) + urea + glucose)
● NK (nonketotic, i.e. no ketones in blood or urine).

22
Q

What is the mx of hyperglycaemia?

A

IV fluid: 1 L stat then 1 L over 1 hour, then 2 hours, then 4 hours, then 8 hours
Sliding scale insulin

23
Q

mx of hypoglycaemia?

A

if unable to eat (i.e. drowsy/vomiting) give IV glucose via a cannula, e.g. 100mL 20% glucose.

If unable to eat and no cannula give IM glucagon 1mg.

24
Q

mx of AKI?

A

500ml IV stat, 1L 4 hrly
Check causes and complications (hyperkalaemia, fluid overload, acidosis)
ABG, catheter, urinalysis, bloods

25
Q

Antidote to benzodiazepine OD?

A

flumazenil

26
Q

what is the mx for htn?

A

> 150/95mmHG or >135/85mmHg + risk of CVD
then give:
<55 yrs or diabetes: ACE-i
55 yrs/ afro-carribean :CCB

27
Q

mx for chronic HF?

A

ACE-i + BB

+ ARB –> nitrates –> spironolactone

28
Q

mx of AF?

A

Rhythm control:
`Who? – if young/symptomatic AF/first episode of AF/AF due
to treated precipitant (e.g. sepsis or electrolyte disturbance).
How? – cardioversion: electrical or pharmacological
(amiodarone 5mg/kg IV over 20–120mins). The patient will
require anticoagulation if more than 48 hours since onset.

Rate

  1. Beta blocker (e.g. atenolol 50-100mg once daily)
  2. Calcium-channel blocker (e.g. diltiazem 120mg OD) (not preferable in heart failure)
  3. Digoxin load, then start 62.5-125mcg (only in sedentary people, needs monitoring and risk of toxicity)
29
Q

mx of stable angina?

A

GTN PRN
RF modification - statin, aspirin + other RF modification
Anti-angina drug: 1) BB 2) CCB
Referral to cardiology for revascularisation

30
Q

mx of asthma?

A
  1. Add short-acting beta 2 agonist inhaler (e.g. salbutamol) as required for infrequent wheezy episodes.
  2. Add a regular low dose inhaled corticosteroid.
  3. Add an oral leukotriene receptor antagonist (i.e. montelukast).
  4. Add LABA inhaler (e.g. salmeterol). Continue the LABA only if the patient has a good response.
  5. Consider changing to a maintenance and reliever therapy (MART) regime.
  6. Increase the inhaled corticosteroid to a “moderate dose”.
  7. Consider increasing the inhaled corticosteroid dose to “high dose” or oral theophylline or an inhaled LAMA (e.g. tiotropium).
  8. Refer to a specialist.
31
Q

What is the mx of diabetic nephropathy and how is this checked for?

A

s checking
an albumin–creatinine ratio (ACR) as (1) an early indicator of
diabetic nephropathy, and (2) a predictor of cardiovascular disease,
e.g. microalbuminuria (ACR ≥ 3mg/mmol) indicates the need for ion).
an ACE-inhibitor. Ironically, ACE-inhibitors can worsen acute kidney
injury but in the chronic setting (with careful monitoring) offer
significant cardiovascular and renal prot

32
Q

Mx of Parkinsons?

A

If mild PD with limited benefit from levodopa yet then give dopamine agonist (such as ropinirole) or MAO-inhibitor (such
as rasagiline)
otherwise give co-beneldopa

33
Q

mx of seizures?

A

● Generalized seizures – sodium valproate
● Absence seizures – ethosuximide
● Focal seizures – carbamazepine or lamotrigine

34
Q

mx of Alzheimers?

A

● If mild/moderate dementia then treat with acetylcholinesterase
(AChE) inhibitors; donepezil, rivastigmine and
galantamine.
● If moderate/severe dementia then treat with NMDA antagonist
(memantine).

35
Q

What blood test should be initiated before giving azathioprine

A

S-methyl

transferase (TPMT)

36
Q

Examples of DMARDs

A

methotrexate or

sulfasalazine or hydroxychloroquine

37
Q

Gve an examples of a stool softener and its indication

A

Docusate

Foecal impaction

38
Q

Gve an examples of a bulking agent laxativr?

A

Isphagula husk

39
Q

examples of stimulant laxative

A

senna

bisacodyl

40
Q

examples of osmotic laxatives

A

lactulose

phosopahate enema

41
Q

mx of hyperkalaemia?

A 
5–10 UNITS OF
ACTRAPID® (or
NOVORAPID®) IN
50ML OF 50%
DEXTROSE OVER
5–15 MIN IV

calcium gluconate 10% by slow intravenous injection

Neb salbutamatol

42
Q

What is the best anti-epileptic drug for pregnancy?

A

lamotrigine

43
Q

How do you decide on the first line PO hypoglycaemic drug for T2DM?

A

Sulphonylureas (e.g. glipizide or gliclazide) first line is patient is normal/ underweight or creatinine >150
Metformin first line if overweight and cretinine <150

44
Q

Mx of COPD exacerbation?

A

First:
24% oxygen in CO2 retainers
salbutamol nebuliser
ipratropium bromide 500mcg neb

Then PO/ IV steroids

IF fail to respond to treatment consider ITU referral and aminophylline

45
Q

Mx of bowel obstruction?

A

drip and suck with a NGT

If that doesnt work consider antiemetic - cyclizine or odansetron appropriate.

46
Q

What should you consider when doing fluids post AKI

A

After renal failure patients can experience a polyuric phase in which urine output is higher than input → dehydration + electrolyte disturbance.

Normally fluid charts should have similar input and output (allow 10-15% difference due to insensible losses). Input may be higher than output in dehydration/ renal failure when we’re pumping them full of fluids. But vice versa is worrying.

To decide on what to prescribe look at total output and divide that by 24 hrs e.g. 6L output - do 24/6 - 4 hrly fluids

47
Q

Rules for fluid prescrbing

A

Look at patient’s bloods!! If they are hypokalaemic replace with K+, if they are upper end of normal for sodium use 5% dextrose

Potassium should never be given at a rate over 20mmol/ hr

Maintenance: 30ml/kg/day; 1mmol/kg of K, Na and Cl, 50-100g/day glucose

High calcium → give 0.9% sodium chloride, 1L in 4 hrs

PSA (7 decks)

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