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DPD interactive cases > General (5) > Flashcards

General (5) Flashcards

1
Q

What determines whether a patient presenting with an acute infective exacerbation of asthma needs oxygen?

A

Oxygen saturations on room air

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2
Q

Once the oxygen has been dealt with, what is the next step in the management of an acute infective exacerbation of asthma?

A

Salbutamol nebulizer

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3
Q

What device is used to deliver oxygen to patients with COPD?

A

Venturi mask (24%)

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4
Q

What is the target range for oxygen saturation in a patient with COPD?

A

88-92%

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5
Q

Why is it bad to give COPD patients 100% oxygen?

A

It diminishes the hypoxic drive to breathe and can result in CO2 retention

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6
Q

Describe the steps taken in the management of a patient with an acute infective exacerbation of asthma.

A

Oxygen (if required)
Salbutamol nebuliser (2.5-5 mg qds)
Ipratropium bromide nebulizer
Steroids (these take some time to act)

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7
Q

If the patient does not respond to oxygen/salbultamol/IB/steroids, what might you consider giving them?

A 
Aminophylline infusion (e.g. theophylline)
Competitive, non-selective phosphodiesterase inhibitor --> increased cAMP --> activates PKA, inhibits TNF a --> decrease inflammation
Non-selective adenosine r antag
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8
Q

Which drug is sometimes used in an exacerbation of asthma?

A

Magnesium sulphate

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9
Q

At what point would you consider non-invasive ventilation (CPAP) in a patient with an acute infective exacerbation of COPD?

A

If the patient has developed respiratory acidosis with a high CO2

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10
Q

What is the best means of providing palliative treatment of bony pain in a patient with metastatic prostate cancer?

A

Radiotherapy

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11
Q

Which two drugs does co-dydramol consist of?

A

Dihydrocodeine

Paracetamol

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12
Q

What types of drugs are tamsulosin and finasteride and what are they used for?

A

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)

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13
Q

Which prostate condition is tamsulosin and finasteride not particularly useful in treating?

A

Metastatic prostate cancer

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14
Q

State another cause of bone pain.

A

Vitamin D deficiency

NOTE: giving vitamin D supplements can help reduce bone pain

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15
Q

After the administration of morphine, nitrates and aspirin, what is the next most important step in the management of a patient suffering a STEMI?

A

Percutaneous coronary intervention

ACEi is a part of LT Mx

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16
Q

Which two drugs will patients with STEMI and NSTEMI both require in their initial management?
What’s the differences?

A

Morphine (+ Metaclopromide)

GTN

17
Q

What is morphine often prescribed with?

A

Metoclopramide

18
Q

What are the modes of administration of nitrates that are used in the management of STEMI/NSTEMI?

A 
Sublingual (initially) - spray
GTN infusion (may be needed sometimes)
19
Q

What instruction must you give to nursing staff once you decide to put a patient on a GTN infusion?

A

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

20
Q

List the drugs used to anticoagulate in STEMI and NSTEMI

A

STEMI

  • Aspirin
  • Clopidogrel

NSTEMI
- Fondaparinux OR
LMWH

21
Q

What is the first treatment you must give to a hyperkalaemic patient? (>6.5 or any ECG changes)

A

Calcium gluconate 10 mL 10%

NOTE: this stabilises the heart

22
Q

What is the next treatment you give to a hyperkalaemic patient?

A

Insulin + dextrose (50 ml 20% or 50%)

b agonist is also a part of Mx

23
Q

What is the first step in the management of a patient with a possible stroke?

A

CT Head scan

24
Q

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?

A

Capillary ketones

This is required to confirm the diagnosis of DKA

25
Q

Which parameter can you not judge accurately from a VBG?

A

pO2

26
Q

Why would pCO2 be low in a patient with DKA?

A

Hyperventilation (Kussmaul breathing) will cause low CO2

27
Q

What happens to bicarbonate in the acute phase of an acidosis?

A

It will drop

28
Q

Why are doctors encouraged to avoid ABGs where possible in patients presenting with DKA?

A

They are painful and may discourage patients from coming to the hospital; minimal added value

29
Q

Which parameters are you particularly interested in when doing an ABG on a patient with suspected DKA?

A

pH
pCO2
Bicarbonate

30
Q

Under what conditions might you consider doing an ABG on a patient with DKA?

A

If they are hypoxic

31
Q

What is oxybutynin and what is it used for?

A

Anticholinergic
It reduces detrusor instability
It is used to treat urinary frequency and urge incontinence

32
Q

Describe the initial management of a patient with lower urinary tract symptoms resulting from BPH.

A

Tamsulosin

33
Q

Which operation may be performed in a patient with BPH?

A

TURP

34
Q

List a differential diagnosis for a single acutely painful and swollen joint.

A

Septic arthritis
Crystal arthritis
Worsening of seronegative arthritis (e.g. reactive arthritis, enteropathic arthritis)
Connective tissue disease

35
Q

What must you exclude in the case of a single acutely painful joint?

A

Septic arthritis

36
Q

What is the first step in the management of a patient with possible septic arthritis?

A

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

37
Q

What would cause an acutely painful, cold and pulseless leg?

A

Acute limb ischaemia

38
Q

What is the next step in the management of a patient with confirmed acute limb ischaemia?

A

IV heparin

Then refer to a vascular surgeon

39
Q

What are 4 sero-ve arthritis?

A

Reactive Arthritis
Enteropathic arthritis
Ankylosing spondylitis
Psioriatic arthropathy

DPD interactive cases (8 decks)

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