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C21 Phase 2/3 > ISCE cards > Flashcards

ISCE cards Flashcards

1
Q

STEMI

A

Ix - ECG, FBC, LFTs, U&Es, lipids, troponin, D dimer (if chest pain non-specific), blood pressure

Mx - A-E approach. Call senior. Give 300mg aspirin. Refer to cardiology. If PCI available, do within 2 hours. If not available, give ticagrelor and aspirin for fibrinolysis.

Secondary prevention: aspirin + clopidogrel. Lifestyle changes. ACEi, beta blocker, statin.

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2
Q

NSTEMI

A

Ix - ECG, FBC, LFTs, U&Es, lipids, troponin, D dimer (if chest pain non-specific), blood pressure.

Mx - A-E approach, call senior/cardiology. Give ticagrelor and aspirin. If unstable, will need angiography to investigate if PCI needed.

Secondary prevention: aspirin + clopidogrel. Lifestyle changes. ACEi, beta blocker, statin.

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3
Q

Acute heart failure

A

Mx - IV loop diuretics
O2
Nitrates (only give if cardiac ischaemia and not hypotensive)
CPAP (if in resp failure)

If in cardiogenic shock:

  • dobutamine
  • ventricular assist
  • noradrenaline
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4
Q

Chronic heart failure

A

Ix - Pro-BNP, lipids, blood gas?, FBC, LFTs, U&Es, ECG

Mx - 1st line: ACEi + beta blocker
- 2nd line: aldosterone/mineralocorticoid antagonist

Both options increase K+ so monitor

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5
Q

Peri-arrest bradycardia

A

Mx

1st - IV atropine 500mcg up to 3g max
2nd - transcutaneous pacing
3rd - isoprenaline/adrenaline infusion

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6
Q

Peri-arrest tachycardia

A

Mx

3x DC shocks
If no improvement:

  • Broad complex: if irregular needs underlying cause treated. If regular give loading dose amiodarone and 24hr infusion.
  • Narrow complex: If irregular likely AF so give beta blockers or cardiovert if less than 48 hours. If regular do vagal manoeuvres followed by adenosine.
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7
Q

Pericarditis

A

Ix - ECG (saddle-shaped ST elevation, PR depression), transthoracic echo, inflammatory markers, troponin

Mx - admit if unstable or feverish. Avoid physical exertion. Give NSAIDs and colchicine.

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8
Q

Aortic dissection

A

Ix - chest XR, CT angio, tranoesophageal echo, lactate, FBC, U&Es, LFTs.

Mx - A-E assessment, call vascular surgeons. Analgesia, control blood pressure. Potentially need surgery.

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9
Q

Infective Endocarditis

A

Ix - blood culture, FBC, CRP, U&Es, LFTs, obs, ECG, urine dip, transthoracic echo

Mx - IV abx, surgical valve replacement

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10
Q

Angina

A

Ix - FBC, CRP, ECG, exercise-stress ECG

Mx - aspirin + statin. lifestyle changes. Sub-lingual GTN. Beta blocker and/or calcium channel blocker (NOT VERAPAMIL)

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11
Q

AF

A

Ix - ECG (can offer ambulatory if coming and going), FBC, CRP, LFTs, U&Es, obs, clotting, TFTs

Mx - assess A-E if unstable. If <48hrs can be cardioverted. Beta blocker/calcium channel blocker/digoxin for rate control. Offer DOAC depending on clot risk.

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12
Q

Hypertension

A

Ix - clinic BP, ambulatory BP, investigate for potential underlying cause

Mx - If signs of end-organ damage -> hospital admission for specialist management. Otherwise:

ACEi/ARB for most under 55s
Amlodipine for over 55s or under 55s of Afro-Caribbean heritage
If still raised then above can be used in combination
If still raised indapamide can be added

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13
Q

Acute exacerbation of COPD

A

Ix - ABG, Chest XR, sputum culture, FBC, CRP

Mx - A-E approach. Call senior help. Oxygen therapy, Salbutamol neb. Ipratropium bromide if no improvement. Oral steroids should be given for all exacerbations. Non-invasive ventilation is the last line.

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14
Q

Asthma attack

A

Ix - peak flow, ABG, chest XR, FBC, CRP

Mx - Assess A-E. Oxygen. Salbutamol nebs. Oral/IV steroids. Ipratropium bromide if no improvement. Call senior help. Single dose IV MgSO4. Abx if evidence of infection.

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15
Q

Pulmonary Embolism

A

Ix - Wells score, CTPA, chest XR, D dimer

Mx - DOAC in stable patients. If unstable, thrombolysis should be given. Oxygen therapy can be given if desaturated. Call for senior help.

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16
Q

Pneumonia

A

Ix - CURB-65, Chest XR, sputum sample, legionella urinary antigen (if high risk), FBC, CRP, blood gas, U&Es

Mx - if severe, A-E approach, call senior, start sepsis 6 protocol. In community, manage with amoxicillin

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17
Q

Pneumothorax

A

Ix - chest XR, FBC, D dimer, troponins if associated chest pain, ECG

Mx - if less than 2cm air then conservative mx. If more than 2cm then aspirate, if not successful then insert chest drain. Lifetime ban from scuba diving, smoking should be discouraged to prevent recurrence. Can fly again 1 week post check up XR

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18
Q

Pleural Effusion

A

Ix - chest XR, FBC, D dimer, troponins if associated chest pain, ECG, USS, CT (to look for underlying cause)

Mx - aspiration (can also be investigated for cause), sepsis 6 if concerned

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19
Q

COPD

A

Ix - peak flow, spirometry, Chest XR, FBC

Mx - smoking cessation, pneumococcal vaccine, annual influenza vaccine, pulmonary rehab. SAMA/SABA is 1st line. If worsening must determine if asthmatic features:

W/ asthmatic features: start LABA + ICS. If still not effective, add LAMA for triple therapy.

W/o asthmatic features: LABA + LAMA

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20
Q

Asthma

A

Ix - peak flow, spirometry, FeNO testing

Mx - 1st line: SABA
2nd line: SABA + low dose ICS
3rd line: SABA + ICS + LTRA

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21
Q

Bronchiectasis

A

Ix - peak flow, spirometry, CT

Mx - physical training (e.g. inspiratory muscle training), postural drainage, antibiotics for exacerbations, immunisations

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22
Q

Lung cancer

A

Ix - chest XR, bronchoscopy, CT, EBUS, FBC, LFT, bone profile, U&Es

Mx - chemo/radio/surgery

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23
Q

Pulmonary fibrosis

A

Ix - peak flow, spirometry, chest XR, ANA +ve, FBC, U&Es

Mx - pulmonary rehab, O2 therapy

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24
Q

TB

A

Ix - Mantoux test (latent TB), sputum smear, sputum culture, chest XR, NAAT (rapid test)

Mx - Active TB: rafampicin, isoniazid, ethambutol, pyrazinamide for 2 months. Rifampicin and isoniazid for further 4 months.

Latent: 3 months isoniazid + rifampicin. OR 6 months of pyrazinamide

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25
Q

Ectopic Pregnancy

A

Ix - vital signs, pregnancy test, FBC, LFTs, U&Es, CRP, TVUSS

Mx - If unstable take ABCDE approach. Refer gynae. If embryo <35mm, unruptured, asymptomatic, no heart beat and low hcg then expectant management. If <35mm, unruptured, no heart beat and low HCG then can be treated with methotrexate. In all other cases should be treated surgically. Give analgesia.

If compromised fertility can opt for salpingotomy as opposed to salpingectomy.

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26
Q

Cholangitis

A

Ix - LFTs, U&Es, FBC, CRP, USS

Mx - Refer gastro. Analgesia. IV abx, ERCP

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27
Q

Acute hepatitis

A

Ix - FBC, U&E, CRP, LFTs, hepatitis serology

Mx - A - no tx
B - antivirals
C - antivirals
D - none
E - none

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28
Q

Bowel obstruction

A

Ix - FBC, CRP, LFTs, U&Es, lactate, abdo XR, abdo CT,

Mx - Refer surgeons. Analgesia. NBM, IV fluids, nasogastric tube, surgery, (if risk of perf give abx)

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29
Q

Appendicitis

A

Ix - FBC, U&E, LFTs, CRP, lactate, pregnancy test, urinalysis, USS, CT if clinical doubt

Mx - ABCDE approach. Refer gastro surgeons. Analgesia. Appendicectomy

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30
Q

Pancreatitis

A

Ix - FBC, U&Es, LFTs, CRP, amylase, lipase, USS/contrast CT to look for underlying cause

Mx - Fluid resuscitation, measure urine output, analgesia, attempt oral intake but if not possible then nasogastric tube can be used, abx if infective picture.

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31
Q

Peritonitis

A

Ix - FBC, U&Es, LFTs, CRP, cultures, paracentesis

Mx - cefotaxime

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32
Q

Variceal haemorrhage

A

Ix - endoscopy, FBC, LFTs, lactate, clotting, group and save

Mx - ABCDE approach. Call for senior help. Terlipressin and abx. Treated using endoscopic management.

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33
Q

Ovarian torsion

A

Ix - pregnancy test, FBC, U&Es, LFTs, CRP, TVUSS

Mx - Analgesia, refer gynae, diagnostic/treatment laparotomy.

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34
Q

Testicular torsion

A

Ix - thorough examination. FBC, U&Es, STI screen, LFTs, CRP, urinalysis

Mx - analgesia. Refer urology for urgent surgical exploration.

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35
Q

Epididymo-orchitis

A

Ix - thorough examination. FBC, U&Es, STI screen, LFTs, CRP, urinalysis

Mx - depends on cause. Treat underlying infection ie, STI/UTI

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36
Q

AAA

A

Ix - vital signs, FBC, group and save, lactate. CT if stable enough

Mx - urgent senior help. Urgent referral to vascular surgeons.

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37
Q

Endometriosis

A

Ix - FBC, CRP, STI screen if indicated, TVUSS, diagnostic laparotomy

Mx - NSAIDS/paracetamol. COCP, progestins. If no improvement a GnRH analogue may be an option, or surgical removal of endometrial tissue from the abdomen.

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38
Q

PID

A

Ix - FBC, urinalysis, STI screen, high vaginal swab, pregnancy test

Mx - abx and analgesia

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39
Q

IBD

A

Ix - FBC, stool culture, CRP, U&Es, LFTs, foecal calprotectin, tissue transglutanimase, endoscopy, colonoscopy and biopsy,

Mx - Medical: mesalazine, steroids, biologics
Surgical: colectomy

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40
Q

IBS

A

Ix - FBC, ESR, CRP, tTG, ?colonoscopy if significant concern

Mx - antispasmodics, laxatives/loperamide depending on stool symptoms, FODMAP diet

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41
Q

Coeliac disease

A

Ix - tissue transglutaminase, IgA, endoscopic intestinal biopsy

Mx - gluten-free diet

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42
Q

Diverticular disease

A

Ix - FBC, CRP, LFTs, U&Es, FIT, colonscopy, CT

Mx - analgesia. Increase dietary fibre. Mild flairs can be treated with abx. Abscesses or recurrent flairs can be treated with surgeries.

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43
Q

Haemorrhoids

A

Ix - examination

Mx - increase dietary fibre, laxatives, local anaesthetic/steroid creams, surgery for large haemorrhoids

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44
Q

Peptic ulcer

A

Ix - H.pylori test, stool sample, FBC,

Mx - PPI, abx if H.pylori +ve

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45
Q

GORD

A

Ix - CRP, endoscopy, ECG

Mx - PPI, diet modification if known triggers

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46
Q

post partum haemorrhage

A

Ix - vital signs, group and save, FBC, clotting

Mx - Assess A-E, call senior help. oxytocin/syntometrin, 2 large bore resus cannulae, warmed fluids, blood transfusion, oxygen, catheterise

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47
Q

Miscarriage

A

Ix - speculum examination, TVUSS, beta HCG, rhesus status, group and save, FBC, vital signs

Mx - Expectant management can be attempted if haemodynamically stable. If expectant management unsuccessful, can be managed medically using misoprostol. If still unsuccessful or if haemodynamically unstable, can be managed surgically.

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48
Q

Hyperemesis Gravidarum

A

Ix - vital signs, FBC, CK, LFTs, U&Es, urinalysis, ECG, BMI,

Mx - plain, bland foods. Cyclizine and/or prochlorperazine. Admission for IV rehydration.

49
Q

Pre-eclampsia

A

Ix - repeated BP readings, urinalysis, foetal HR auscultation, clotting, FBC, U&Es, LFTs, fundoscopy

Mx - ask for senior help/refer gynae. Admission under obstetric team if BP >160/110. Labetalol. CTG. USS for polyhydramnios/IUGR. Give aspirin and clexane. If risk of eclampsia then premature delivery may be needed.

50
Q

HELLP

A

Ix - FBC, U&Es, clotting, LFTs, blood film, blood pressure, CTG, urinalysis,

Mx - call senior help. intravenous magnesium sulphate, antihypertensives, blood products and timely delivery

51
Q

Placenta praevia

A

Ix - abdominal/vaginal USS, CTG, group and save, clotting, rhesus status, FBC, U&Es, LFTs

Mx - placenta may migrate during pregnancy but if near delivery is still low lying then caesarean is indicated

52
Q

Placental abruption

A

Ix - abdominal/vaginal USS, CTG, group and save, clotting, rhesus status, FBC, U&Es, LFTs

Mx - if foetal distress - emergency c-section. If no distress >36 weeks induce for vaginal delivery. <36 weeks admit and observe closely for monitoring, delivery should be attempted as soon as foetus is able to be safely delivered or if mother is unstable. Give anti-D if rhesus -ve

53
Q

Fibroids

A

Ix - FBC, U&Es, LFTs, CRP, pregnancy test, speculum examination, TVUSS

Mx - mirena/alternative hormonal contraceptive for menorrhagia. Short term GnRH can be used medically, alternatively myomectomy/endometrial ablation/hysterectomy would be surgical options.

54
Q

Atrophic Vaginitis

A

Ix - speculum examination. FBC, TVUSS, bone profile (if concern of endometrial cancer)

Mx - Vaginal lubricants and moisturisers. Topical oestrogen.

55
Q

Gestational diabetes

A

Ix - bedside BM, OGTT, USS (polyhydramnios), urinalysis, BP

Mx - self glucose monitoring. Dietary advice. If target glucose not met in 1-2 weeks, start metformin. If still not met, start insulin.

56
Q

cholestasis

A

Ix - FBC, U&Es, LFTs, urinalysis, CTG, vital signs

Mx - ursodeoxycholic acid, vitamin K. Can induce labour from 37 weeks but not evidence-based.

57
Q

Croup

A

Ix - clinical diagnosis based on resp exam findings. Can also do chest XR

Mx - Emergency: assess A-E, call senior. Give O2, steroids and adrenaline.

If stable: one-off dose of oral dexamethasone

58
Q

Bronchitis

A

Ix - clinical diagnosis

Mx - analgesia, good fluid intake, abx if indicated

59
Q

Epiglottitis

A

Ix - ABG if concerned about airway, chest XR, vital signs

Mx - Assess A-E, call senior. Visualise epiglottis, O2, abx

60
Q

Intussusception

A

Ix - ultrasound is now the investigation of choice and may show a target-like mass

Mx - air insufflation

61
Q

Neonatal sepsis

A

Ix - blood cultures, blood smears, FBC, CRP, LFTs, U&Es, VBG, urine culture and sensitivity, lumbar puncture

Mx - call senior help, assess A-E. O2, IV abx,

62
Q

Meningitis (paediatric)

A

Ix - blood cultures, vital signs, FBC, U&Es, LFTs, lumbar puncture,

Mx - assess A-E, call senior help. Abx, steroids and fluid resuscitation.

63
Q

Compartment syndrome

A

Ix - Largely clinical based on hx. Lactate, vital signs, FBC, CRP. Intracompartment pressures can be taken.

Mx - Urgent fasciotomy

64
Q

NOF

A

Ix - XR, FBC, CRP

Mx - Refer ortho. Analgesia. intracapsular - hemiarthroplasty, extracapsular - DHS

65
Q

Osteomyelitis

A

Ix - FBC, CRP, blood cultures, urine output, lactate, MRI, bone profile

Mx - IV abx

66
Q

Osteoporosis

A

Ix - FRAX score, DEXA scan, bone profile, CRP, ESR, FBC, U&Es, LFTs

Mx - calcium and vitamin D supplements. Alendronate.

67
Q

Cauda Equina

A

Ix - DRE, full neurological assessment, FBC, B12 and folate, CRP, bone profile, MRI spine

Mx - Analgesia, insertion of urinary catheter. Refer neurosurgeons. Laminectomy/tx of underlying cause

68
Q

Ischaemic stroke

A

Ix - FBC, lipids, HbA1c, LFTs, U&Es, clotting, CT head,

Mx - immediate 300mg aspirin. Refer neurology/stroke team. thrombolysis/thrombectomy. Long-term clopidogrel + lifestyle management eg, smoking cessation

69
Q

Guillain-Barre

A

Ix - lung function tests, b12 and folate, LP, FBC, CRP, ECG, LFTs, U&Es, CK, glucose,

Mx - IVIg, analgesia, refer neurology, physiotherapy, VTE prophylaxis

70
Q

Bell’s palsy

A

Ix - clinical diagnosis

Mx - eye care, oral prednisolone

71
Q

Carpel tunnel

A

Ix - clinical diagnosis supported by nerve conduction studies

Mx - splinting and rest. Surgical decompression can also be done

72
Q

Parkinson’s

A

Ix - lying and standing BP, MOCA, FBC, U&Es, LFTs, TFTs, glucose, HbA1c, B12 and folate,

Mx - levodopa, MOA-inhibitors

73
Q

Headache (Ix only)

A

Ix - vital signs, examination of the face, LFTs, CRP, U&Es, FBC. (LP and CT head if clinical suspicion)

74
Q

MND

A

Ix - LFTs, CRP, U&Es, FBC, B12 and folate, MRI, nerve conduction studies

Mx - Riluzole, ventilatory support, PEG

75
Q

MS

A

Ix - lying and standing BP, MOCA, FBC, U&Es, LFTs, TFTs, glucose, HbA1c, B12 and folate, HIV, MRI brain, LP

Mx - methylprednisolone to treat acute flair. DMARDs long-term

76
Q

Status Epilepticus (Mx)

A

Mx - A-E approach, call for senior help. Observations. Oxygen, FBC, U&Es, lactate, toxicology screen, CRP, bone profile, magnesium, LFTs, blood cultures. Bedside BM and ketones.

IV lorazepam, if no improvement after 10 mins can give 2nd dose. If still no improvement give phenytoin.

77
Q

Steven-Johnson’s Syndrome

A

Ix - vital signs, FBC, U&Es, CRP, LFTs, ?skin biopsy

Mx - admit, urgent derm review and intensive care management. A-E approach. Supportive management, fluids etc, stop any potentially causative drugs

78
Q

Eczema Herpeticum

A

Ix - vital signs, FBC, U&Es, CRP, LFTs, ?skin biopsy

Mx - IV aciclovir, careful monitoring and review under derm

79
Q

Erythroderma

A

Ix - vital signs, FBC, U&Es, CRP, LFTs, ?skin biopsy, albumin

Mx - admit, urgent review. Assess A-E, cover in thick emollient creams head to toe, antihistamines for itch, fluids if dehydrated

80
Q

Shingles

A

Ix - vital signs, routine bloods, otherwise clinical diagnosis

Mx - analgesia, advice to avoid vulnerable groups while infectious, antivirals if within first 72 hours

81
Q

Acne (Mx)

A

Mx - 1st - topical retinoids/topical abx
2nd - combined topical retinoid + abx
3rd - oral abx + topical retinoid
4th - isotretinoin under specialist review

COCP can be trialled in females. Isotretinoin cannot be prescribed if risk of pregnancy and either LARC or 2 forms of contraception should be used.

82
Q

Bullous Pemphigoid

A

Ix - vital signs, FBC, U&Es, CRP, LFTs, ?skin biopsy

Mx - refer derm. Oral steroids, topical abx can also be used

83
Q

Pyoderma gangrenosum

A

Ix - vital signs, FBC, U&Es, CRP, LFTs, ?skin biopsy

Mx - oral steroids. Refer derm. Immunosuppressives. Postpone any surgery.

84
Q

Septic arthritis

A

Ix - vital signs, FBC, U&Es, CRP, LFTs, joint aspiration, joint XR, blood cultures

Mx - Call senior. Assess A-E. Analgesia. IV abx, and aspirate joint to relieve swelling if needed

85
Q

Osteoarthritis

A

Ix - FBC, U&Es, LFTs, bone profile, joint XR

Mx - lifestyle and activity advice. Simple analgesia initially. Intraarticular steroid injection can also be trialled. Refer ortho if worsening and for potential joint replacement.

86
Q

Rheumatoid arthritis

A

Ix - FBC, U&Es, LFTs, bone profile, anti-CCP, rheumtoid factor, joint XR

Mx - analgesia. Refer rheumatology. Initial steroid dose and DMARD monotherapy (usually methotrexate) first line. Flairs treated with IM or oral pred.

87
Q

Subarachnoid haemorrhage

A

Ix - obs, FBC, U&Es, clotting, CRP, LFTs, cultures, CT head (if normal within 6 hours consider alternative. If normal after 6 hours + LP)

Mx - Assess A-E. lie patient flat, analgesia, VTE prophylaxis, give nimodipine, refer neurosurgeons for clipping of aneurysm

88
Q

Gout

A

Ix - obs, FBC, U&Es, CRP, ESR, LFTs, serum urate. Consider joint aspiration and joint XR if querying septic joint.

Mx - colchicine for 4 days. If renal impairment use NSAIDS, or 3rd line is steroids if not suitable for either. Allopurinol should be started 2 weeks after initial attack with colchicine cover. Also advise lifestyle changes: reduce alcohol and fatty food.

89
Q

Ankylosing Spondylitis

A

Ix - physical examination. FBC, CRP, U&Es, ESR, HLA-B27, XR spine (inc sacroiliac joints), chest XR

Mx - encourage regular exercise. Refer rheumatology. NSAIDs, physiotherapy, sulfasalazine.

90
Q

SLE

A

Ix - physical examination, FBC, CRP, U&Es, LFTs, ESR, ANA, anti-dsDNA, anti-Smith

Mx - NSAIDs, sunscreen, refer rheumatology, hydroxychloroquine,

91
Q

Sjogrens

A

Ix - physical examination. Anti-Ro, Anti-La, ANA, Schirmers Test (tear test with filter paper at the eye)

Mx - refer rheumatology, artificial tears and saliva. Pilocarpine can also be given.

92
Q

Polymyalgia rheumatica

A

Ix - physical examination. FBC, U&Es, ESR, CRP, LFTs, CK

Mx - prednisolone on a gradually reducing dosage

93
Q

Neuroleptic malignant syndrome

A

Ix - obs, FBC, U&Es, CK, LFTs, CRP

Mx - stop antipsychotic. Admit to medical ward, likely ITU. Call senior. Assess A-E. Give IV fluids. Dopamine agonist.

94
Q

Serotonin syndrome

A

Ix - obs, FBC, U&Es, CK, LFTs, CRP

Mx - supportive including IV fluids, benzodiazepines, refer seniors, admit, serotonin antagonists

95
Q

Assess for suicide risk

A
  • Employment status
  • Relationship status and family
  • Hx of self harm
  • Drug/alcohol abuse
  • previous attempts
  • made efforts to avoid discovery
  • planned suicide
  • leaving a written note
  • final acts such as sorting out finances
  • violent method of suicide
96
Q

First episode of psychosis (Mx)

A
  • Refer psych. Atypical antipsychotics first-line. Can try alternative atypical or typical if 1st line ineffective. 3rd line clozapine. Optimise cardiovascular risk factors.
97
Q

Depression (mx)

A

Mild: guided self-help, CBT, SSRIs

Severe: Refer CMHT. SSRIs/SNRIs + CBT. In cases of catatonia or treatment resistant depression, ECT can be used.

98
Q

Anxiety Mx

A

Psychoeducation. SSRIs and self-guided CBT.

99
Q

Conjunctivitis

A

Ix - can swab the eye if ?bacterial infection but likely viral

Mx - warm compresses and simple analgesia. If bacterial can give chloramphenicol eye drops. If allergic can give antihistamines.

100
Q

Idiopathic Intracranial Hypertension

A

Ix - fundoscopy, LP, CT head, FBC, U&Es, LFTs, CRP, HbA1c

Mx - weight loss, acetazolamide, therapeutic lumbar puncture

101
Q

Acute angle glaucoma

A

Ix - fundoscopy, tonometry

Mx - Pilocarpine, timolol, and apraclonidine eye drops. IV acetazolamide. Laser iridotomy.

102
Q

Orbital Cellulitis

A

Ix - obs. FBC, cultures, eye examination including acuity and movements, CT head and orbits

Mx - Admit. Refer ophthalmology. IV abx

103
Q

Primary open-angle Glaucoma

A

Ix - slit lamp examination, fundoscopy, tonometry and corneal thickness measurement

Mx - Prostaglandin analogue eye drops. Beta blocker eye drops.

104
Q

Macular degeneration

A

Ix - Fundoscopy. Slit lamp examination.

Mx - VEGF. Laser photocoagulation.

105
Q

Anterior uveitis

A

Ix - HLA-B27, fundoscopy, spine XR (look for Ank Spond.)

Mx - Urgent ophthalmology r/v. Atropine eye drops, steroid eye drops.

106
Q

Optic neuritis

A

Ix - FBC, U&Es, CRP, MRI brain and orbits

Mx - IV methylprednisolone. Consider referral to neurology if 2nd presentation or other sx as ?MS

107
Q

Ramsay Hunt

A

Ix - examination of ears and mouth. Assess hearing and consider stroke sx.

Mx - oral aciclovir and prednisolone. Eye care.

108
Q

Menierres

A

Ix - examination of ears and mouth. Assess hearing and consider stroke sx.

Mx - Inform DVLA. IM prochlorperazine for acute attacks. Betahistine is given to prevent.

109
Q

BPPV

A

Ix - examination of ears and mouth. Assess hearing and consider stroke sx.

Mx - Epley manoeuvre. Offer betahistine if struggling but limited evidence for improvement.

110
Q

Otitis media

A

Ix - examination of ears and mouth. Assess hearing and palpate for mastoid tenderness.

Mx - At home supportive management in majority of cases. Abx only to be given if: sx longer than 4 days, systemically unwell, immunocompromised, <2 years and bilateral, if perforated

111
Q

Otitis externa

A

Ix - examination of ears and mouth. Assess hearing and palpate for mastoid tenderness.

Mx - topical abx and steroids. If not successful consider ear swab and oral abx.

112
Q

Acoustic neuroma/Vestibular schwannoma

A

Ix - examination of ears and mouth. Assess hearing and consider stroke sx. MRI cerebellopontine angle. Audiometry

Mx - urgent referral to ENT. Observation, surgery, radiotherapy are all options.

113
Q

Diabetic ketoacidosis

A

Ix - bedside BM, obs, ketones, ABG, FBC, HbA1c, U&Es, LFTs

Mx - Assess A-E. Call senior help. IV fluids. Stop short-acting insulin but continue long-acting. Start insulin infusion and potassium replacement.

114
Q

Addisonian Crisis

A

Ix - obs, U&Es, LFTs, FBC, CRP,

Mx - Assess A-E. Call senior help. IV fluids, steroid replacement

115
Q

Thyrotoxicosis

A

Ix - Obs, TFTs, thyroid antibodies, FBC, CRP, U&Es, LFTs

Mx - emergency admission. Call senior and assess A-E. Beta blockers. ‘Block and replace’ (carbimazole + levothyroxine) to control T4.

116
Q

Myxoedemic coma

A

Ix - Obs. TFTs, thyroid antibodies, FBC, CRP, U&Es, LFTs

Mx - Emergency admission, assess A-E and call senior. IV thyroid replacement, IV fluids and steroids, correct electrolyte imbalances. Rewarming might be necessary.

117
Q

Diabetes Mellitus Type 2

A

Ix - HbA1c, lipids, FBC, random and fasting glucose, LFTs, TFTs, U&Es

Mx - lifestyle and diet. Metformin unless renal impairment. If CVD risk factors add SGLT-2 inhibitors or consider monotherapy if metformin contraindicated. Add DPP-4 if still not under control. Consider insulin therapy.

118
Q
A

C21 Phase 2/3 (18 decks)

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