Misc

Question 1

Hb normal ranges

Answer 1

Men: 130-180 g/L
Female: 115-160 g/L

Question 2

Hb transfusion indication

Answer 2

<70 g/L in hospitalised haemodynamically stable pts

<80 g/L if undergoing orthopedic or cardiac surgery, or if CVS disease

Question 3

What dose a positive fluid balance mean?

Answer 3

that fluid input is greater than output

might suggest problem with kidney or CVS

Question 4

normal range BP
high
low

Answer 4

90/60 –> 120/80

high : 140/90 or higher
low : 90/60 or lower

Question 5

What features suggest a moderate asthma attack?

Answer 5

• PEFR 50-75% best or predicted
• Speech normal
• RR <25 / min
• PR <110 bpm

Question 6

What features suggest a severe asthma attack?

Answer 6

• PEFR 33-50% best or predicted
• Can’t complete sentences
• RR > 25/min
• PR > 110 bpm

Question 7

What features suggest a life-threatening asthma attack?

Answer 7

• PEFR < 33% best or predicted
• O2 sats <92%
• Silent chest, cyanosis or feeble resp effort
• Bradycardia, dysrhythmia or hypotension
• Exhaustion, confusion or coma

[In addition, a normal pCO2 in acute asthma attack indicated exhaustion and should, therefore, be classified as life-threatening]

Question 8

Reversible causes of CA

Answer 8

hypoxia
hypo-/hyperkalaemia/metabolic
hypovolaemia
hypothermia

thrombosis - coronary or pulmonary
tension pneumothorax
tamponade - cardiac
toxins

Question 9

HbA1c Targets:

Answer 9

• 48 mmol/mol (6.5%) for ind treated with lifestyle alone or who are taking 1 antidiabetic drug not associated with hypoglycaemia e.g. metformin
  
  • 53 mmol/mol (7%) for adults on an antidiabetic drug associated with hypo
    53 for those taking 2 or more antidiabetic drugs (orals agents and/or insulin)

Question 10

Example of short-acting insulin

Answer 10

e.g. soluble insulin, actrapid
- Works within minutes
- Used in variable rate IV infusions to maintain near normoglycaemia
Used in continuous subcut insulin infusions i.e. insulin pump regimens

Question 11

Example of intermediate acting insulin

Answer 11

e.g. isophane insulin Insulatard
- Often mixed with soluble insulin to make “bi-phasic insulin”
Usually administered BD

Question 12

Example of long acting insulin

Answer 12

e.g. insulin glargine, Lantus
- Prolonged duration of action
- BD or OD
Doesn’t need to be given with food

Question 13

1st line Rx in T2DM

Answer 13

1. Metformin = 1st line treatment option for adults with T2 DM
   - eGFR to be measured at baseline
   § Metformin CI’d if eGFR is <30
   - Total daily dose to be increased over several weeks
   - Dose should be reduced if eGFR is below 45
   - Standard-release regimen to be prescribed
   - Trial of MR only if pt gets GI SE from standard release

If metformin CI’d or not well tolerated, the following can be first line alternative:
- A dipeptidyl peptidase-4 (DPP-4) inhibitor i.e. the gliptins; or
- Pioglitazone; or
- A sulfonylurea
SGLT-2