Management

Question 1

Disease name

Answer 1

Management

Question 2

Type I Diabetes

Answer 2

Aim for a HbA1c goal of less than 6.5%. Combination of insulin, diet, exercise regulation and monitoring of blood glucose. Yearly screening for BP, eGFR, lipids, smoking, funduscope, foot check, urinary protein.

Question 3

Type II Diabetes

Answer 3

Aims are to remove symptoms of uncontrolled diabetes, avoid emergencies, reduce risk developement, early detection, avoid adverse effect on QofL

Question 4

Diabetic retinopathy

Answer 4

Laser therapy can be used to cauterize areas of microhaemorrage

Question 5

HIV

Answer 5

HAART, antiretroviral, supportive care (counselling…) treat any symptoms. General medical checkups often.

Question 6

Sepsis

Answer 6

Sepsis 6: high flow oxygen, take blood, give broad spectrum antibiotics, give IV fluids, measure lactate and haemoglobin, measure hours lay urine output.

Question 7

Varicella

Answer 7

Antiviral therapy not routinely given for children. In adults, aciclovir or valaciclovir first line antivirals.

Question 8

Shingles

Answer 8

VZ immunoglobulin, aciclovir

Question 9

Encephalitis

Answer 9

Supportive treatement and aetiology targeted antiviral/Anti-microbial.

Question 10

Ebola infection

Answer 10

No treatement works very well. Convalescent plasma can maybe help. rVSV-EBOV vaccine exists and 100% effective in ring distribution

Question 11

Cellulitis

Answer 11

Systemic antibiotic with MRSA cover like Vancomyocin IV

Question 12

Gall stone disease

Answer 12

Laparoscopic Cholecystectomy

Question 13

Pancreatitis

Answer 13

Endoscopic retrograde cholangiopancreatography

(look at pancreatic duct and get rid of stones). Oxygen, iv fluids, analgesia, antibiotics, NGT.

Question 14

Appendicities

Answer 14

Appendicectomy

Question 15

Upper GI Bleeding

Answer 15

Get support of critical care team. Give fluids. Stop offending drugs, give plasma, correct clotting, platelet transfusion, consider antibiotics.Non variceal: PPI. Variceal: Terlipressin (like vasopressin). Endoscoping bimodal (2) intervention (clipping, banding, injections, burning vessel).

Question 16

Diverticular disease

Answer 16

Haartman’s proceudre, antibiotics, fibre rich diet.

Question 17

IBD (Crohn’s disease)

Answer 17

1. Steroids/ antibiotics (short term only). Followed by immunosuppressants, biologics (antiTNF, anti0integrin, IL23&IL12 and oral nutrition with supplements quite good but bad taste. Last resort treatment is Surgery.

Question 18

IBD (Ulcerative Colitis)

Answer 18

1. Initial treatment include steroids, aminosaliculates (5-ASA, mesalazine). 2. second line give immunosupressants like thiopurines, methotrexate, ciclosorine. 3. give biologics like anti-tnf, anti-integrin. JAK inhibitors (tofacitinib). Last resort is surgery (20%)

Question 19

Coeliac disease

Answer 19

Only treatment available is a strict gluten free diet. Duodenal biopsy is performed and is very sensitive for disease.

Question 20

Alcoholic hepatitis

Answer 20

Prednisolone,

Question 21

Tuberculosis

Answer 21

Rifampicin + isoniazid (6-12 months) + pyrazinamide (2months) _ ethambutol (1-2 months). In resistant TB, consider other antibiotics.

Question 22

Meningitis

Answer 22

Immediate broad spectrum antimicrobials should be given, then focused once culture results are back. An adjunctive corticosteroid (dexamethosone) may be given

Question 23

Osteoarthritis

Answer 23

Local analgesia, exercise, intra-articular corticosteroids, knee replacement surgery if very bad.

Question 24

Psoriatic arthritis

Answer 24

first line moisterizer, then topical corticosteroid, vit D analogues. Then phototherapy, then methotrexate, acitrecin, ciclosporin, fumaric acid. Then 3rd line is biologics. Criteria for biologic is severe psoriasis, failed standard treatement,

Question 25

Rheumatoid arthritis

Answer 25

Anti-inflammatory treatments: NSAIDs, then DMARDs (traditional then biologics then targeted biologics) then steroids for flare ups. Anti-tnfa antibody treatement biologics gold standard (some humanised versions)

Question 26

Systemic lupus erythematosus

Answer 26

Aim is to achieve remission while minimizing drug related toxicity. Drugs escalating: Hydroxychloroquine (for patients with mild symptoms) ,corticosteroids short course for flareups, azothiopine, micofenalate, methotrexate, belimumab (apoptosis of autoreactive b cells)

Question 27

Systemic sclerosis

Answer 27

Early: low dose steroids, immunosuppressives. Late: symptomatic control and BP control

Question 28

Raynaud’s

Answer 28

Keep warm, ca channel blocker, prostacyclin injection

Question 29

Antiphospholipid syndrome

Answer 29

Strokes/TIAs primarily, anticoagulation treatement of choice. Primarily organic brain symptoms like headache psychosis ect. immunosupression treatment. In obstetrics, heparin and aspirin. Warfarin in patients which have had thrombosis.

Question 30

Atopic dermatitis (Eczema)

Answer 30

Initial emollients, then topical steroids/ calcineurin inhibitors alternatives, then systemic steroids (prednisolone) or phototherapy. Last line is methotrexate, cliclosporin, azathioprine, biologics (dulipumab is good. IL4-IL13 inhibitor).

Question 31

IgA nephropathy (main cause of glomerulonephritis)

Answer 31

Blood pressure control is most important, immunosupression may be benificial in some cases.

Question 32

Nephrotic syndrome

Answer 32

Diuretics (be cautious of hypovolaemia), ACE inhibitors (good for kidneys), anticoagulation (increased risk of VTE), statin (cholesterol)

Question 33

Minimal change disease (cause of nephrotic syndrome)

Answer 33

Steroids and sometimes orhter immunosuppression

Question 34

Membranous nephropaty (cause of nephrotic syndrome)

Answer 34

Immunosupression

Question 35

Urinary Tract Infection

Answer 35

Antibiotics.(based on culture results). Continuous prophylaxis or self-start antibiotic can be given for recurrent. Trimethoprin first line in females. INcreased fluid intake, general hygiene. Cranberry juice good for prophylaxis. Topical estrogens