Internship - EBCHC

Question 1

Mx plan for PEP:

Answer 1

1. VCT
2. Pt. counselled
3. Start HAART
4. STI prophylaxis
5. Bloods: Hb / Cr / ALT / Hep B / RPR
6. TCB for results - PHC

Question 2

Drug Rx for PEP:

Answer 2

1. Ceftriaxone 250 mg IMI stat
2. Azithromycin 1 g PO stat
3. TDF + FTC 1 tab dly PO x1/12
4. Alluvia 2 tabs BD PO x1/12
5. Maxalon 10 mg TDS PO x1/12
6. Buscopan 10 mg TDS PO x1/12
7. Loperamide 4 mg PRN PO x1/12

Question 3

Rabies Prophylaxis - Wound Mx:

Answer 3

1. Flush well with soap and water or water alone for 5 min
2. Apply disinfectant (70% alcohol or iodine solution)
3. Handle the wound as little as possible
4. Avoid vigorous debridement
5. Do not inject local anaesthetic - may spread the virus

Question 4

Rabies Prophylaxis - What is Category 1?

Answer 4

1. Licking intact skin

No wound

Question 5

Rabies Prophylaxis - What is Category 2?

Answer 5

1. Nibbling uncovered skin
2. Superficial scratch w/out bleeding

Skin NOT intact

Question 6

Rabies Prophylaxis - What is Category 3?

Answer 6

1. Bites or scratches that bleed
2. Lick of mucous membranes
3. Lick of broken skin

Question 7

Rabies Prophylaxis - Mx of Category 1 Exposure:

Answer 7

1. No vaccine or Ig

Question 8

Rabies Prophylaxis - Category 2 Exposure Mx:

Answer 8

1. Rabies vaccine

Question 9

Rabies Prophylaxis - Mx of Category 3 Exposure:

Answer 9

1. Rabies vaccine
2. Rabies Ig

Question 10

How to give rabies vaccine?

Answer 10

1. 1 amp/dose for adults & children
2. Give IMI
3. Adults - deltoid mm.
4. Children - anterolateral thigh

Question 11

Full course for rabies vaccination:

Answer 11

1. Day 0 (1st day of vaccination)
2. Day 3
3. Day 7
4. Day 14
5. Day 28 (only immunocompromised pts)

Question 12

Dose of rabies Ig:

Answer 12

1. 20 IU/kg

300 IU in 2 ml ampoule

Question 13

How to give RiG?

Answer 13

1. Give RiG immediately after vaccine administration
2. Infiltrate into wound as much as possible
3. Multiple wounds - need greater vol. - dilute RiG in = vol. of N/S
4. Give rest IMI
5. Give IMI in opposite limb to vaccine

Question 14

Sites for RiG injection:

Answer 14

1. Adults - Deltoid
2. Children - Anterolateral thigh

Question 15

Lignocaine - max dose without adrenaline:

Answer 15

5 mg/kg

Question 16

Lignocaine - max dose with adrenaline:

Answer 16

7 mg/kg

Question 17

Approach to severe hypergylcaemia - GR > 13

Answer 17

1. Emphasise lifestyle modifications

Question 18

Approach to severe hypergylcaemia - GR > 15

Answer 18

1. Optimise chronic Rx

Question 19

Approach to severe hypergylcaemia - GR 18-20:

Answer 19

1. 6U Actrapid S/C stat
2. Advise pt. to drink 8 glasses of water
3. Repeat GR after 1 hr

Question 20

Approach to severe hypergylcaemia - GR 20-23:

Answer 20

1. 10U Actrapid S/C stat
2. Advise pt. to drink 8 glasses of water
3. Repeat GR after 1 hr

Question 21

Approach to severe hypergylcaemia - GR > 23:

Answer 21

1. Refer to Cas
2. 1L N/S IVI
3. 10 U Actrapid IVI

Question 22

Approach to severe HPT:

SBP ≥ 160 or DBP ≥ 110

Answer 22

1. Exclude neurovascular Sx - H/A, visual disturbances, slurred speech, chest pain, dyspnoea, acute onset weakness, paraesthesia,
2. If present - send to Cas
3. If absent - Rest & repeat BP in 1 hr
4. Still BP ≥ 160/110 - give Amlodipine 10 mg PO stat & repeat BP in 1 hr
5. Still BP ≥ 160/110 - give furosemide 40 mg PO stat & repeat BP in 1 hr
6. Still BP ≥ 160/110 - Send to Cas