COTE

Question 1

Dx of postural hypotension ?
2 causes?
2 Non pharma mx?
1 pharma mx?

Answer 1

drop in systolic >20mmHg when standing

Anti HTN meds
hypovolaemia
autonomic failure - parkinsons / diabetes

Education on recognising and taking action
high salt diet

fludrocortisone -> increase intravascular volume

Question 2

tool to differentiate delierum and dementia

Answer 2

Confusion Assessment Method CAM

Question 3

How does penicillin work?
How can bugs develop resistance?
How to combat this?

Answer 3

Inhibit cell wall synthesis

Beta lactamase production

Add beta lactamase inhibitor Eg Co-amox (clavulanic acid) / tazocin (tazobactam)

Question 4

Drug for stress incontinence

Answer 4

duloxetine -> increases tone of sphincter

Question 5

2 classes of drug that can increase incontinence?

2 that can cause retention

Answer 5

Diruetics, sedatives eg opiates

anticholinergics, NSAIDs

Question 6

DEXA scan - difference between T and Z score

Answer 6

T - number of SDs below that of average young adult

Z - SDs when matched for age/gender…..

Question 7

2 Ix for myeloma screen

Answer 7

urinary bence jones protein

serum eletrophoresis

Question 8

2 mx for hyperCa

Answer 8

IV fluids

IV Bisphosphonates

Question 9

4 End of life Sx and drug for each

Answer 9

Pain - morphine 
Agitation - midazolam 
Nausea  - cyclizine 
Resp secretions - hyosine 
dyspnea - morphine 

These were all adviced by the Liverpool Care Pathway