MaM Paper 9 Flashcards
Supraventricular Tachycardia Management on haemodynamically stable patients
Vagal maneuvers are initially attempted and, if unsuccessful, the patient will be treated with adenosine (6 mg → 12 mg → 12 mg).
Supraventricular Tachycardia management stable patient with asthma
Vagal Manoeuvres first
Verapamil 2nd line
Because adenosine can precipitate dangerous bronchoconstriction in patients with a background of severe asthma, so verapamil may be used in such cases.
Anal Fissure 1st line treatment
Conservative measures such as sitting in a shallow, warm bath can also help relieve the pain. If these measures fail to resolve the symptoms, topical GTN should be considered
1st line treatment treatment of Tonic-Clonic Seizures
Sodium valproate is considered the first-line treatment option for generalised tonic-clonic seizures, myoclonic seizures and tonic or atonic seizures.
1st line for focal seizures
Lamotrigine
2nd line for tonic-clonic seizures
Lamotrigine
1st line for abscence seizures
Ethosuximide
A 71-year-old man has been placed on a monitor bed in the cardiology ward after presenting with chest pain at rest. His troponins were 322 ng/mL and 1322 ng/mL with minimal ECG changes so he was diagnosed with an NSTEMI and is due to undergo a coronary angiogram within the next two days. He has been started on aspirin and ticagrelor.Which of the following medications should this patient be prescribed?
A)Dabigatran
B)Fondaparinux
C)Tinzaparin
D)Unfractionated Heparin
E)Rivaroxaban
B)
Patients who have had an NSTEMI should be started on SC Fondaparinux 2.5 mg OD. It is a factor Xa inhibitor that can establish a decent degree of anticoagulation in patients who have been admitted with an NSTEMI. Patientswho require urgent PCI (within 2 hours) should be started on an unfractionated heparin infusion ahead of the procedure.
A 5-year-old boy is brought to the developmental paediatrics clinic with concerns abouthis eyes. He was noted to have a squint as a baby which his parents were hoping would improve over time, but it appears to have worsened. Furthermore, he has trouble walking downstairs and has fallen a few times. On examination, the child’s left eye is adducted and deviated superiorly on forward gaze and he keeps his head tilted to the left. Which cranial nerve is most likely to be affected?
A)Optic Nerve
B)Oculomotor Nerve
C)Trochlear Nerve
D)Abducens Nerve
E)Vestibulocochlear Nerve
Answer: C
The trochlear nerve(CN IV) provides motor innervation to the superior oblique muscle. The role of the superior oblique is to medially rotate, abduct and depress the eye. Therefore, a trochlear nerve palsy will mean that the eye has a tendency to move superiorly and mediallyupon forward gaze resulting in diplopia. Patients may try to compensate for this by tilting their head such that their pupils align. Patients tend to have trouble performing tasks that involve maintaining a downgaze such as walking downstairs or reading abook.
Movements of the Trochlear Nerve
The trochlear nerve(CN IV) provides motor innervation to the superior oblique muscle. The role of the superior oblique is to medially rotate, abduct and depress the eye. Therefore, a trochlear nerve palsy will mean that the eye has a tendency to move superiorly and medially upon forward gaze resulting in diplopia.
Antibiotic for long-term prevention of infective exacerbations of COPD?
Azithromycin is a macrolide antibiotic that may be used in the prevention of infective exacerbations of COPD. It is usually given at a dose of 250 mg 3-times weekly to patients who have had frequent exacerbations of COPD (usually considered 4 or more in a year). It is highly effective against the main causes of infective exacerbations of COPD (e.g. H. influenzae, S. pneumoniaeand M. catarrhalis)
When do we use Trastuzumab (Herceptin®)
Trastuzumab (Herceptin®) is given to breast cancers that are HER2 positive.
When do we use Hormone therapy in Breast Cancer ?
After surgery for hormone receptor-positive cancers
When do we use Chemo in Breast Cancer?
Chemotherapy is either given as a neo-adjuvant or adjuvant in breast cancer treatment.
Neo-adjuvant chemotherapy is given before surgery to large tumours (> 4cm) to reduce the tumour burden ahead of surgical intervention.
Adjuvant chemotherapy is given after surgery to:
- young women,
- cancer with lymph node positive status,
- high grade histological features,
- ER negative cancers.
How do we treat Oestrogen receptor positive cancers?
Surgery + Tamoxifen/aromatase inhibitors.
Tamoxifen is a selective oestrogen receptor modulator given to women who are pre and perimenopausal. Anastrozole is an aromatase inhibitor and is given to postmenopausal women as most oestrogen is produced through aromatisation in this age group.
