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Y6 PSA > [MAN] Planning management > Flashcards

[MAN] Planning management Flashcards

1
Q

Summarise HASBLED score.

A

HTN
Abnormlal renal / liver function
Stroke
Bleeding tendency
Labile INR
Elderly >65
Drugs (aspirin/NSAID) or alcohol

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2
Q

Explain how you interpret HASBLED score

A 
0= low risk, start anticoag if necescary 
1-2 = consider anticoag
3+ = high risk of major bleeding

NOTE: this has been replaced by the ORBIT score

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3
Q

What route of administration contraceptive must you give for women on enzyme inducer?

A

NOT ORAL (as functioning dose will be affected)

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4
Q

Important rules when taking biphosponates

A

once weekly preparations
do not take together with calcium - as calcium reduces biphossphonate absorption
avoid food for 2 hours (reduces absorption)
swalow with a full gla s of water and remain upright for 30mins

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5
Q

what is 1% weight/volume if volume is 100ml

A

1g
so
1% of a solution i 1g/100ml

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6
Q

do you need to measure plasma digoxin regularly?=

A

NO - unless you suspect toxicity or non compliiance

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7
Q

what should INR be on day before surgery

A

<1.5

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8
Q

what do you need to do if INR is >1.5 on day before surgery

A

give ORAL VIT K

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9
Q

what must you do to ALL ANTICOAGULANTS (incl aspirin) before surgey?

A

STOP THEM 5 DAYS BEFORE

INCL ASPIRIN

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10
Q

Why must you stop metformin the day before surgery?

A

if GFR <60

because otherwise there is a risk it will cause LACTIC ACIDOSIS or ISCHAEMIA (incl AKI)

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11
Q

what is first line therapy for DM in CKD

A

SULPHONYLUREA

NOT metformin if GFR less than 30

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12
Q

what must you do if pt on ACEi develops a cough

A

STOP ACEi

change to ARB

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13
Q

what ix must you do if on antipsychotic and some CV RF eg smoking

A

ECG 1 week after prescription

this will establish pt QT interval while on olanzapine

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14
Q

where can you search details about converting pred to other steroid doses in BNF

A

“GLUCOCORTICOID THERAPY”

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15
Q

what drug quickly solves dyspepsia / indigestion?

A

“ANTACID”

e.g. Magnesium carbonate

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16
Q

what is the BEST INDICATOR of resolution of DKA

A

serum ketones

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17
Q

What can you give if pt is having a MILD ALLERGIC REACTION (not bad enough for adrenaline)? Or if they still have symptoms, but are stable, after adrenaline?

A

give oral chlorphenamine

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18
Q

What time of day must you never give diuretics?

A

in the EVENING (or patients will be up all night passing urine!)

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19
Q

Which antiemetic is contraindicated in parkinsons?

A

Metoclopramide

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20
Q

What is the effect of ALCOHOL on GLUCOSE?

A

It causes HYPOGLYCAEMIA

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21
Q

What are common side effects of tramadol?

A

Agitation and hallucinations (especially in elderly)

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22
Q

What must you take into consideration when prescribing weak opioids to elderly>

A

their side effect profile

  • codeine causes constipation
  • tramadol causes agitation and hallucinations
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23
Q

What weak opioid is best in elderly with diarrhoea

A

Codeine

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24
Q

What is the fastest clinical marker to show improvement of pneumonia

A

RR

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25
Q

If a patient’s pain is not controlled on paracetamol, what are the options?

A

Codeine or Tramadol

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26
Q

Treatment option for severe HAP?

A

Pip-taz
Ceftazidime
Ceftriaxone
Cefuroxime

NOTE: if MRSA confirmed or suspected, add vancomycin/teicoplanin

Can be found under ‘Respiratory system infections’ on the BNF

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27
Q

Treatment option for non-severe HAP?

A

Co-amoxiclav

If pen-allergic: doxycycline

Can be found under ‘Respiratory system infections’ on the BNF

28
Q

What is an example of an antacid? What is the normal dose?

A

Magnesium carbonate 10mL 3 times daily

Dose to be taken with water

NOTE: contraindicated with hypophosphataemia

29
Q

Productive cough + SOB?

A

Main differentials include heart failure and pneumonia

30
Q

Antibiotics for epiglottitis

A

cefotaxime/ceftriaxone

also give steroids
+ rifampicin to close contacts

31
Q

Short-term anxiolytic (e.g. anxious about an invasive procedure)

A

Diazepam
Chlordiazepoxide
Lorazepam
Oxazepam

Benzodiazepines are the mainstay of short-term management of severe anxiety.

32
Q

What is the first-line treatment for non-bullous localised impetigo?

A

Hydrogen peroxide 1% cream apply 2-3 times a day for 7 days

If he was systemically unwell or at higher risk of complications, a topical (e.g., fusidic acid) or oral (e.g., flucloxacillin) antibiotic should be offered. Clarithromycin is a suitable alternative for patients who are penicillin allergic.

33
Q

What is the recommended treatmetn for whooping cough?

A

Macrolides e.g. clarithromycin

34
Q

What can be used to induce ovulation in women with anovulatory cycles?

A

Clomifene

NOTE: Weight loss (in overweight and obese women) and metformin can restore ovulation, but in women with polycystic ovary syndrome (PCOS).

35
Q

What test would confirm anovulatory cycles?

A

Mid-luteal progesterone

36
Q

If bacterial conjunctivitis does not resolve, what can be give?

A

Chloramphenicol or fusidic acid may be used in the management of bacterial conjunctivitis, but they are not recommended first-line as most cases self-resolve within a few days.

A delayed prescription can be given with advice to use the medication if symptoms have not begun to resolve after 3 days.

37
Q

What type of medication (class) is beclometasone?

A

Inhaled corticosteroid

An appropriate prescription for ashtma would be: Beclometasone 200–400 micrograms inhaled twice daily

38
Q

What is the dose and medication for suspected meningococcal disease in a 2 year old in the GP setting?

A

Benzylpenicillin 600mg IM

39
Q

Which drug is used in the management of stress incontinence?

A

Duloxetine (e.g. 40mg PO twice daily)

Duloxetine is a serotonin-noradrenaline reuptake inhibitor (SNRI) which sphincter tone, resulting in a reduction in symptoms of stress incontinence.

40
Q

Above which blood pressure is urgent admission indicated?

A

180/100 mmHg in combination with signs of end-organ damage such as retinal haemorrhage or papilloedema, or life-threatening symptoms.

41
Q

What is the most appropriate analgesia for acute severe pain seconday to limb fracture?

A

The BNF recommends a starting dose of up to 5mg intravenous morphine every 4 hours, which can be titrated according to the response (the dose can also be adjusted more frequently during the titration phase).

Typically in the setting of acute pain in opioid-naive patients, IV morphine is administered in 2.5mg increments with re-assessment after each dose to guide the need for further analgesia.

It should be noted that there are many caveats to this; for example, the dose may need to be reduced in the elderly or those with poor renal function or increased in those who are already taking long-acting opioid medications. Opioids are also often avoided in cases of significant head injury where they may complicate examination findings and worsen respiratory depression.

42
Q

Is fentanyl stronger or weaker than morphine?

A

around 100 times more potent than morphine

A fentanyl patch is slow-release and would not be helpful in managing the acute pain

43
Q

What is the medical management of ectopic pregnancy?

A

IM methotrexate

If medical management fails or if the ectopic pregnancy ruptures, surgery will be required (salpingotomy or salpingectomy, depending on the status of the contralateral fallopian tube).

44
Q

What is the medical management for termination of pregnancy up to 24 weeks gestation?

A

Vaginal misoprostol can be used following mifepristone to terminate pregnancy up to 24 weeks.

45
Q

What is the first line medication in myasthenia gravis?

A

Pyridostigmine

First-line treatment is an acetylcholinesterase (AChE) inhibitor such as pyridostigmine. This effectively increases the concentration of acetylcholine within the synaptic cleft to allow for symptomatic relief.

46
Q

What can be used in acute myasthenic crises?

A

Prednisolone

Patients would usually present with symptoms associated with respiratory failure requiring intubation and ventilation.

47
Q

What is the recommended antibiotic in patients with cellulitis who are allergic to penicillin?

A

Clarithromycin 500mg PO

(Erythromycin in pregnant)

48
Q

Where can you find information medical management of insect bites?

A

If you look at the insect bites and stings section it says: “Antibacterials are not recommended for an insect bite or sting unless the patient has signs or symptoms of an infection. For the management of patients with a suspected infection, see Cellulitis and erysipelas.”

49
Q

What might the following symptoms suggest: reduced level of consciousness, worsening ascites and possible coagulopathy suggested by the bruising (PMH: alcoholic cirrhosis)?

A

Hepatic encephalopathy

Acutely, this patient should be prescribed lactulose 30-50ml three times daily; this is the first-line management of overt hepatic encephalopathy and has been shown to reduce mortality. Rifaximin (550mg PO BD) is a potential second-line option.

50
Q

What is the first line management for overt hepatic encephalopathy?

A

Lactulose 30-50ml three times daily

Rifaximin (550mg PO BD) is a potential second-line option.

51
Q

What is the first line pharmacological management of GORD?

A

Alginic acid 2 doses as required up to 12 doses a day (for a child aged 1-23 months with weight 4.5kg and above).

52
Q

What is the most appropriate management for an eclamptic seizure (in a pregnant patient with known pre-eclampsia)?

A

Administer IV magnesium sulfate 4g

Labetalol is a beta-blocker used in the management of hypertension in pregnancy and pre-eclampsia, and should also be commenced here, but is less urgent than administering magnesium sulfate to prevent complications of the seizure including coma, fetal damage or death.

53
Q

What is the most appropriate management of CAP in a patient who is pregnant and has a penicillin allergy?

A

Erythromycin 500mg PO

NOTE: Doxycycline 200mg PO is incorrect as tetracycline antibiotics are contraindicated in pregnancy.

54
Q

If a patient is having a migraine and is vomiting severely, what route can triptans be administered by?

A

Subcut
Intranasally

55
Q

What is the adrenaline dose in anaphylaxis?

A

Adrenaline 500 micrograms IM (0.5 mL of 1:1000).

56
Q

What dose of folic acid should be given during pregnancy if the woman has a first degree relative with spina bifida?

A

folic acid 5mg PO daily (high dose) until week 12 of pregnancy

Patients at low risk of conceiving a child with neural tube defects should take folic acid at a lower dose of 400 micrograms daily.

57
Q

Why should patients over the age of 50 be given antiviral treatment for shingles?

A

to reduce the risk of long term post-herpetic neuralgia

Dose: Aciclovir 800mg PO 5 times a day for 7 days

58
Q

Treatent of second episode of Clostridium difficile infection in the last 12 weeks

A

oral fidaxomicin 200mg BD

59
Q

For severe croup not controlled with corticosteroids, what should be given?

A

Nebulised adrenaline 1:1000 should be given

The dose is 400 micrograms/kg (max 5mg)

This can be administered by diluting 1:1000 adrenaline solution with sterile sodium chloride 0.9%.

60
Q

Medical management of ascites for cirrhosis of the liver and malignant disease.

A

Spironolactone 100mg OD

61
Q

What is the first-line therapy for the management of haemodynamically stable patients with pulmonary embolism?

A

Either apixaban or rivaroxaban, providing there are no contraindications.

These drugs are generally given for 3-6 months, depending on whether the episode of venous thromboembolism was provoked or unprovoked. The patient has a normal renal function, and therefore a DOAC is preferable to LMWHs such as dalteparin sodium; these are recommended to be given second-line according to the latest guidance.

62
Q

When is unfractionated heparin used in PE management?

A

For massive PE

Alternative: thrombolytic agents such as alteplase

63
Q

Reversal agent for benzodiazepine toxicity?

A

Flumazenil

64
Q

What treatment is appropriate when salicyclate concentration exceeds 700mg/L (in an overdose)?

A

Haemodialysis

Other indication: severe metabolic acidosis/

65
Q

Best antibiotic choices for suspected meningitis/meningococcal sepsis in child under 3 months old?

A

IV cefotaxime and amoxicillin

In children over 3 months old, IV ceftriaxone is used.

66
Q

What is the first line antihypertensive in a diabetic patient?

A

ACE inhibitor (regardless of age or ethnicity - ARB if black)

ACE inhibitors have been shown to reduce microalbuminuria and slow the progress of nephropathy in those with diabetes.

67
Q

How might losartan cause AKI?

A

pre-renal acute kidney injury secondary to dehydration/hypovolaemia

If this happens, WITHHOLD the causative medication

Y6 PSA (32 decks)

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