General (5) Flashcards
What determines whether a patient presenting with an acute infective exacerbation of asthma needs oxygen?
Oxygen saturations on room air
Once the oxygen has been dealt with, what is the next step in the management of an acute infective exacerbation of asthma?
Salbutamol nebulizer
What device is used to deliver oxygen to patients with COPD?
Venturi mask (24%)
What is the target range for oxygen saturation in a patient with COPD?
88-92%
Why is it bad to give COPD patients 100% oxygen?
It diminishes the hypoxic drive to breathe and can result in CO2 retention
Describe the steps taken in the management of a patient with an acute infective exacerbation of asthma.
Oxygen (if required)
Salbutamol nebuliser (2.5-5 mg qds)
Ipratropium bromide nebulizer
Steroids (these take some time to act)
If the patient does not respond to oxygen/salbultamol/IB/steroids, what might you consider giving them?
Aminophylline infusion (e.g. theophylline) Competitive, non-selective phosphodiesterase inhibitor --> increased cAMP --> activates PKA, inhibits TNF a --> decrease inflammation Non-selective adenosine r antag
Which drug is sometimes used in an exacerbation of asthma?
Magnesium sulphate
At what point would you consider non-invasive ventilation (CPAP) in a patient with an acute infective exacerbation of COPD?
If the patient has developed respiratory acidosis with a high CO2
What is the best means of providing palliative treatment of bony pain in a patient with metastatic prostate cancer?
Radiotherapy
Which two drugs does co-dydramol consist of?
Dihydrocodeine
Paracetamol
What types of drugs are tamsulosin and finasteride and what are they used for?
Tamsulosin – a-blocker
Finasteride – Type II and III 5a-reductase inhibitor (5a-r converts Testosterone to dihydroT)
Helps relieve lower urinary tract symptoms e.g. BPH
T also helps with kidney stone passage and urinary retention (relaxes bladder neck muscles and muscle fibres in prostate)
Which prostate condition is tamsulosin and finasteride not particularly useful in treating?
Metastatic prostate cancer
State another cause of bone pain.
Vitamin D deficiency
NOTE: giving vitamin D supplements can help reduce bone pain
After the administration of morphine, nitrates and aspirin, what is the next most important step in the management of a patient suffering a STEMI?
Percutaneous coronary intervention
ACEi is a part of LT Mx
Which two drugs will patients with STEMI and NSTEMI both require in their initial management?
What’s the differences?
Morphine (+ Metaclopromide)
GTN
What is morphine often prescribed with?
Metoclopramide
What are the modes of administration of nitrates that are used in the management of STEMI/NSTEMI?
Sublingual (initially) - spray GTN infusion (may be needed sometimes)
What instruction must you give to nursing staff once you decide to put a patient on a GTN infusion?
Write on the drug chart that you are aiming for systolic blood pressure > 100 mm Hg
This is because GTN can cause hypotension
NOTE: you can titrate up and increase the infusion rate to control the pain but you need to monitor BP at all times
List the drugs used to anticoagulate in STEMI and NSTEMI
STEMI
- Aspirin
- Clopidogrel
NSTEMI
- Fondaparinux OR
LMWH
What is the first treatment you must give to a hyperkalaemic patient? (>6.5 or any ECG changes)
Calcium gluconate 10 mL 10%
NOTE: this stabilises the heart
What is the next treatment you give to a hyperkalaemic patient?
Insulin + dextrose (50 ml 20% or 50%)
b agonist is also a part of Mx
What is the first step in the management of a patient with a possible stroke?
CT Head scan
A VBG of a patient with suspected DKA shows acidosis and high blood glucose. What is the first step in the management of this patient?
Capillary ketones
This is required to confirm the diagnosis of DKA
Which parameter can you not judge accurately from a VBG?
pO2
Why would pCO2 be low in a patient with DKA?
Hyperventilation (Kussmaul breathing) will cause low CO2
What happens to bicarbonate in the acute phase of an acidosis?
It will drop
Why are doctors encouraged to avoid ABGs where possible in patients presenting with DKA?
They are painful and may discourage patients from coming to the hospital; minimal added value
Which parameters are you particularly interested in when doing an ABG on a patient with suspected DKA?
pH
pCO2
Bicarbonate
Under what conditions might you consider doing an ABG on a patient with DKA?
If they are hypoxic
What is oxybutynin and what is it used for?
Anticholinergic
It reduces detrusor instability
It is used to treat urinary frequency and urge incontinence
Describe the initial management of a patient with lower urinary tract symptoms resulting from BPH.
Tamsulosin
Which operation may be performed in a patient with BPH?
TURP
List a differential diagnosis for a single acutely painful and swollen joint.
Septic arthritis
Crystal arthritis
Worsening of seronegative arthritis (e.g. reactive arthritis, enteropathic arthritis)
Connective tissue disease
What must you exclude in the case of a single acutely painful joint?
Septic arthritis
What is the first step in the management of a patient with possible septic arthritis?
Joint aspiration – send for MC&S, Gram-staining, look for crystals
If you’re worried about septic arthritis – give broad-spectrum antibiotics after the aspiration
What would cause an acutely painful, cold and pulseless leg?
Acute limb ischaemia
What is the next step in the management of a patient with confirmed acute limb ischaemia?
IV heparin
Then refer to a vascular surgeon
What are 4 sero-ve arthritis?
Reactive Arthritis
Enteropathic arthritis
Ankylosing spondylitis
Psioriatic arthropathy
