Management of Common Presentations

Question 1

What is the initial management of an MI

Answer 1

Aspirin 300mg
O2 if sats are low
Morphine if in severe pain (with antiemetic)
Clopidogrel or ticagrelor
GTN

Question 2

What is the management of a STEMI

Answer 2

PCI within 2 hours of presentation or think about thrombolysis if PCI is unavailable

Question 3

What is the management of an NSTEMI

Answer 3

BATMAN
Base decision about angiography and PCI on GRACE score
Aspirin 300mg stat dose
Ticagrelor 180mg STAT
Morphine
Antithrombin therapy (fondaparinux)
Nitrate

Question 4

What are the signs of heart failure

Answer 4

Tachycardia, tachypnoea, hypertension, lung crackles, raised JVP and oedema

Question 5

What is the treatment for chronic heart failure

Answer 5

BAMS +/- loop diuretics
Beta blocker
Ace inhibitor/ sacubitril valsartan
Mineralocorticoid receptor antagonist
SGLT2 inhibtior

Question 6

What is the surgical treatment option for HF?

Answer 6

Implantable cardioverter defibrillators

Question 7

What is the treatment of infective endocarditis?

Answer 7

Depends on species. Initial therapy for native valve is amoxicillin +/- gent. For prosthetic valves it is Vancomycin + rifampicin + low dose gentamicin.
4 weeks for native valves and 6 weeks for prosthetic valves

Question 8

What is the treatment for infective endocarditis caused by streprococci (eg viridens)

Answer 8

Benzylpenicillin +/- low dose gent

Question 9

What are the indications for surgery in infective endocarditits?

Answer 9

Severe valve incompetence, aortic abscess, resistant infections, cardiac failure

Question 10

Why is it important to monitor UEs in hypertensive patients

Answer 10

• To look for evidence of end organ damage,
• Many of the drugs used to treat hypertension can cause electrolyte abnormalities eg, thiazide like diuretics can cause hypokalaemia, spironolactone and ACE inhibitors can cause hyperkalaemia

Question 11

What are some secondary causes of hypertension?

Answer 11

ROPED
- Renal disease,
- Obesity,
- Pregnancy/pre-eclampsia,
- Endocrine (cushings)
- Drugs (steroids, NSAIDs, oestrogen)

Question 12

What is the management of SVT?

Answer 12

1. Vagal manovers (valsalva/carotid massage)
2. Adenosine (avoid in asthma/copd)
3. Verapamil or beta blocker,
4. DC cardioversion

Question 13

What are some important signs of lung cancer?

Answer 13

Clubbing, supaclavicular lymphadenopathy, Recurrent chest infections, haemoptysis, weight loss, extra-pulmonary manifestations (SVC obstruction, reccurent laryngeal nerve palsy, horners syndrome)

Question 14

What is the management of interstitial lung disease?

Answer 14

• Remove or treat underlying cause,
• Home oxygen,
• Stop smoking,
• Physio,
• Pneumococcal and flu vaccine

Question 15

What is the presentation of IPF?

Answer 15

SOB and dry cough over 3 months.

Question 16

What is the management of a PE?

Answer 16

depends on severity but in anyone with a suspected PE give a DOAC. Anticoag for 3 months if there was a known cause or over 3 months if there was an unknown cause

Question 17

Management of acute cholecytitis

Answer 17

Conservative - NBM, IV fluids, antibiotics and an NG tube may be needed if vomiting.
Surgical - ERCP to remove stones or cholecystectomy (usually in 72h of symptoms but may need to wait 6 weeks for inflammation to settle)

Question 18

What are some complications of acute cholecystitis?

Answer 18

Sepsis, gallbladder empyema, gangrenous gallbladder or perforation