Management

Question 1

Myocardial Infarction Immediate Mx

Answer 1

MONA
- Aspirin 300mg + Clopidogrel 600mg
- Glycerin Trinitrate 400mcg Spray
- Oxygen - <92%
- Morphine - 2.5mg
Ondansetron
Investigation - Troponin
Percutaneous Coronary Intervention
Thromoblytic Therapy - Alteplase (Main) & Enoxaparin (If rural)

Question 2

CI for Nitrates

Answer 2

Viagra w/in 24 hours
Unstable VS
Prev. Heart Disease

Question 3

CI for Thrombolytic Therapy

Answer 3

Prev hx of Bleeding
Active Bleeding, PUD
Recent Surgery
Hx of Brain bleeding, Clotting, Brain Tumor

Question 4

Myocardial Infarction Long Term Mx

Answer 4

SABA
- Statins - High Dose Rosuvastatin
- ACEi - Perindropril
- Beta Block - Metroprolol
- Aspirin & Clopidogrel
PPI for Anti-platelet
Cardiac Rehab & Lifestyle modification

Question 5

Shingles Mx

Answer 5

Swab if w/ Rash
Antivirals if <72hrs
Panadeine Forte
Avoid Contact with Children and Pregnant
Notify DOH
Investigations - FBE, FBS, HIV
Complications - Post Herpetic Neuralgia

Question 6

Atrial Fibrillation Mx

Answer 6

Investigations (Cause) - 2D Echo (EF, V dx), Blood (TSH, FBE, UEC, eGFR)
CVS RF - S,A,D,E,S
Risk of Clot and Bleed for Blood thinners - CHADSVasc, HASBLED
- Warfarin or Apixiban (W if Valve Prob)
Treat Arrythmia
<48 hrs - Rate (B blocker), Rhythm Control (Med/Shock)
>48 hrs - Rate, 2D Echo

Question 7

Risperidone SE

Answer 7

Metabolic Syndrome - Weight Gain, Inc Sugar and Cholesterol
General SE of Anti-Psychotics - Dizziness, Tremors, Constipation

Question 8

Implications of Fall

Answer 8

Fracture
- Each fall you might fracture your bone
- Like your spine or hip which is hard to fix or to heal
Head Injury
– If you fall this puts you at risk of head injuries
– Create bleeding in the brain, Damage to the brain, Create a new problem
Support
– If you fall there might be no one to help you

Question 9

Pulmonary Edema 2nd to Heart Failure Mx

Answer 9

Inv. - 2D Echo
Immediate - MOND
Morphine, Oxygen, Nitrates, Diuretics
Cardiac Rehab Team
Monitor V/S and Fluids

Long Term
- ACEi, B-blockers, Diuretics
- Lifestyle Modification
- Cardiac Rehab
- Check PMHx to continue meds - Statins, Aspirin

Question 10

Bowel CA Risk Mx

Answer 10

Cat 1 - FOBT every 2 years at 50
Cat 2 - FOBT 2/yr 40-49; Colonoscopy 50 5/yr
Cat 3 - Good to know