Management Regimes

Question 1

Emergency Contraception

Answer 1

1. Levonelle (levonorgestrel)

1.5mg STAT

up to 72h, 84% effective
progestrogen –> stops ovulation, inhibits implantation
vomiting within 2h –> repeat dose

2. EllaOne (ulipristal)

30mg STAT

up to 120h (5 days)
cautions: reduces effect of OCP, difficult in asthma, use only once per cycle
progesterone receptor modulator, inhibits ovulation

3. IUD (copper)
up to 5 days after likely ovulation date, 99% effective
keep in at least until next period
inhibits implantation
give abx if risk of STI

Question 2

Urge Incontinence

Answer 2

1. Conservative

• lifestyle - reduce caffeine, normal fluid intake, weight loss if BMI > 30
• bladder training = gradually increase intervals between voiding over 6 weeks
• intermittent self-catheterisation

2. Medical - stabilise bladder

• antimuscarinics: oxybutynin, tolterodine, solifenacin - relax detrusor
• intravaginal oestrogens if atrophic
• intramural botox injections (unlicensed?)

3. Surgical

• sacral nerve stimulation
• posterior tibila nerve stimulation
• augmentation cystoplasty (increasing size of bladder using tissue taken from gut)

Question 3

Stress Incontinence

Answer 3

1. Pelvic floor exercises
   * at least 3 months
2. Medical
   * duloxetine
3. Surgical

• retropubic mid-urethral tape procedures - TVT, TOT
• open colosuspension
• autologous rectal fascial sling

Question 4

Hypertension

British Hypertension Society

Answer 4

1)

white, under 55 = ACEi, ARB, (or BB, new NICE guidance says no BB until step 4)

black or over 55 = CCB or diurectic

2) A or B + C or D
3) A or B + C + D

4)

• add alpha block
• add spiro
• add second diuretic

Question 5

Mild Community Acquired Pneumonia

(CURB-65 < 1)

Answer 5

1. amoxicillin or doxycycline
2. clarithromycin or amoxicillin

5 – 7 days

Question 6

Severe Community Acquired Pneumonia
(CURB-65 > 2)

Answer 6

1. IV benzylpenicillin/amoxicillin AND Clarithromycin

Oral switch: doxycycline or amoxicillin +/- clarithromycin

7 – 10 days

Question 7

Infective exacerbation of COPD

Answer 7

1. doxycycline
2. amoxicillin or clarithromycin

5 – 7 days

Question 8

Hospital Acquired Pneumonia

Answer 8

1. IV benzylpenicillin and gentamycin
2. Co-amoxiclav

Oral switch: co-amoxiclav

5 – 7 days (total)

Question 9

Aspiration Pneumonia

Answer 9

1. As other pneumonias, + metronidazole

Oral switch: co-amoxiclav

5 – 7 days (total)

Question 10

Complicated UTI

Answer 10

1. IV co-amoxiclav (with IV gentamycin if septic)

Oral switch: trimethoprim

7 – 10 days

Question 11

Uncomplicated UTI

Answer 11

1. Trimethoprim
2. Nitrofurantoin

3 – 7 days

Question 12

Pyelonephritis

Answer 12

1. IV co-amoxiclav and gentamycin
2. Ciprofloxacin

Oral switch: co-amoxiclav

14 days

Question 13

Maintenance Fluid Regime

(Adults)

Answer 13

• 1 salt, 2 sweet

1L 0.9% saline + 20mmol K+ over 8 hours
1L 5% dextrose + 20mmol K+ over 8 hours
1L 5% dextrose + 20mmol K+ over 8 hours