Foundations Doctor App

Question 1

Indication for zopiclone

Answer 1

Short term insomnia

Question 2

Risks of rapid tranquilisation

Answer 2

• Over-sedation causing loss of consciousness
• Loss of airway
• Cardiovascular collapse:
• Arrhythmias / Hypotension / Sudden death
• Respiratory depression
• Acute dystonia
• Neuroleptic Malignant Syndrome
• Interaction with medication (prescribed or illicit including alcohol)
• Damage to the therapeutic relationship
• Underlying coincidental physical disorders

Question 3

First line for rapid tranquilisation

Answer 3

IM lorazepam

Question 4

Second line in rapid tranquilisation if no response

Answer 4

IM haloperidol / olanzepine

Question 5

Second medication in rapid sedation if partial response

Answer 5

Repeat IM lorazepam

Question 6

Management of Bradypnoea caused by benzodiazepines

Answer 6

IV flumazenil

Question 7

Pain medications in palliative care

Answer 7

SC morphine first line

SC oxycodone second line

Question 8

Anxiety medications in palliative care

Answer 8

SC midazolam

Question 9

Nausea medications in palliative care

Answer 9

SC cyclizine
SC levomepromazide
SC haloperidol

Question 10

Secretions medications in palliative care

Answer 10

SC glycopyrronium

SC hyoscine butyl bromide

Question 11

Acute transfusion reaction symptoms

Answer 11

Fever / chills / rigors
Tachycardia
Respiratory distress
Hyper / Hypotension
Syncope
Nausea / General Malaise
Flushing / Urticaria
Pain: Chest / Abdominal / Muscles

Question 12

What does clear / translucent yellow ascetic fluid indicate?

Answer 12

Normal appearance - portal hypertension

Question 13

What does cloudy ascitic fluid suggest?

Answer 13

Infection (SBP), pancreatitis, perforated bowel

Question 14

What does bloody ascitic fluid indicate?

Answer 14

Traumatic tap, malignancy, haemorrhagic pancreatitis

Question 15

What does milky ascitic tap indicate?

Answer 15

Malignancy, lymphoma, TB

Question 16

Slightly high RBCs on ascitic tap

Answer 16

Malignancy, TB

Question 17

Very high RBCs on ascitic tap

Answer 17

Haemorrhage (pancreatitis/ trauma)

Question 18

High neutrophils on ascitic tap

Answer 18

SBP

Question 19

High lymphocytes on ascitic tap

Answer 19

TB

Question 20

High serum ascitic albumin gradient (SAAG)

Answer 20

Transudate - systemic disease - liver / heart / renal failure

Question 21

Low serum albumin ascitic gradient (SAAG)

Answer 21

Exudate - local disease - malignancy / infection

Question 22

Standard pre-op investigations

Answer 22

ECG, CXR, bloods, pregnancy test if appropriate

Question 23

Meds to consider stopping before surgery

Answer 23

Anticoagulants 
Anti-platelet 
Insulin
Hypoglycaemics
Diuretics
ACEi / ARBs

Question 24

Management of anticoagulation prior to surgery

Answer 24

Discussion with haematology and consider cover with shorter acting anticoagulants

Question 25

Management of insulin prior to surgery

Answer 25

Hold on morning of surgery and use sliding scale

Question 26

Management of anti-platelets prior to surgery

Answer 26

Hold 7 days prior to surgery

Question 27

Management of diuretics prior to surgery

Answer 27

Hold on day of surgery

Question 28

Management of ACEi prior to surgery

Answer 28

Hold on day of surgery

Question 29

Management of ARB prior to surgery

Answer 29

Hold on day of surgery

Question 30

Protocol for NBM (when they must stop eating)

Answer 30

2 hours prior to surgery no food or drink 6 hours prior to surgery clear fluids only If time of surgery unknown prep patient ready for 8am

Question 31

Risks of transfusion

Answer 31

Common: fever, flushing, rash, itching Rare, haemolytic reaction, anaphylaxis, transfusion associated circulatory overload, transfusion related acute lung injury, post transfusion purpura, very small risk of blood borne infection