Medicine tutorial

Question 1

Management of PE

Answer 1

• Wells score
• If 4 or less - D-dimer
• If more than 4 - CTPA
• If cannot get result within 4hrs- give LMWH as interim
• 1mg/kg BD if RF
• 1.5mg/kg OD if no RF
• No admission needed if stable - if CTPA +ve give DOACs, if -ve stop LMWH

Question 2

Thunerclap headache causes…

Answer 2

• Subarachnoid haemorrhage - rule out with CT head
• If CT head normal do lumbar puncture 12hrs after onset of symptoms looking for xanthochromia
• Spasm cerebral artery - precipitated by sex

Question 3

Management of SAH

Answer 3

• Embolise using coiling via femoral or radial artery

Question 4

Management of cerebral vasospams

Answer 4

• CCB - nimodipine

Question 5

Management for CA pneumonia

Answer 5

• Amoxicillin if CRB 65 0
• Amoxicillin + Clarithromycin if CRB 65 1 or 2

Question 6

Management pneumothorax

Answer 6

Question 7

Symptoms of hyperventilation

Answer 7

• Breathlessness
• Dizziness
• Pins and needles in hands and feet and around mouth

Question 8

Confirming diagnosis of hyperventilation

Answer 8

• ABG - shows hypocapnia
• Give re-breathe mask and see if improves
• How long can hold breath? If less than 10s - suggests yes, if more than 20s suggests another cause
• Induce hyperventilation - tell pt to breathe fast, if symptoms return = yes

Question 9

Differentials for breathlessness with hypoxia on exertion with normal exam and obs

Answer 9

• PE
• Pneumonia + Pleural effusion?
• Lung cancer
• HF

Question 10

Most common causes of delirium in elderly patients - infective

Answer 10

• Chest or waterworks
• Get CXR and urine MSU

Question 11

Symptoms of hypercalcaemia

Answer 11

• Polyuria
• Painful bones
• Renal stones
• Abdominal groans - N/V, constipation
• Psychiatric moans - lethargy, fatigue, memory loss, psychosis

Question 12

Management of hypercalcaemia

Answer 12

• Give fluids - 0.9% saline
• Maybe furosemide too
• IV bisphosphonates to decrease osteoclast activity if due to high PTH
• Calcitonin?
• Calcimimetic - Cinacalcet
• Do PTH bloods

Question 13

Hyponatraemia differentials

Answer 13

• Thiazide diuretic - if no:
• SIADH - euvolaemic? if no:
• HF - raised JVP, if no:
• Dehydration - low JVP
• Other causes - cirrhosis? Addisons?

Question 14

Dilutional picture on blood tests duggests…

Answer 14

SIADH

Question 15

Management SIADH

Answer 15

Fluid restrict
Tolvaptan?