MSRA

Question 1

Tonsilitis Complications

Answer 1

1) quinsy
2) otitis media
RARELY
3) rheumatic fever
4) glomerulonephritis

Question 2

OVERDOSE MX

1) Paracetamol

2) Salicylate

3) Opioids

4) Benzodiazepines

5) Tricyclic antidepressants

6) Lithium

7)Warfarin

8)Heparin

9)Betablockers

10) Ethylene glycol

11) Methanol

12) Organophosphate insecticides

13) Digoxin

14) Iron

15) Lead

16) Carbon monoxide

17) Cyanide

Answer 2

1) PARACETAMOL
Charcoal if <1hr since ingestion
NAC
Liver transplant

2) SALICYLATE
IV Bicarbonate to urinary alkalisation
Haemodialysis

3) OPIOIDS
Nalaxone

4) BENZODIAZEPINES
Monitor
Flumanzenil in severe/iatrogenic OD (caution due to increased risk of seizures)

5) TCAs
1st line - correct acidosis -> IV Bicarbonate (reduce seizure and arrhythmia risks in severe cases)
2nd - consider lignocaine

AVOID
- 1a antiarrhytmics (Quinidine) - protong depolarisation
- 1c (Flecainide) prolong depolarisation
- 3 (Amiodarone) - prolong QT interval
Ineffective-dialysis

6) LITHIUM
Mild-mod cases
- Volume resuscitation w/ normal saline
Severe
- Haemodialysis
Consider sodium bicarbonate - increasing urinary alkalinity may promote lithium excretion

7) WARFARIN
Vitamin K
Prothrombin complex

8) HEPARIN
Protamine sulphate

9) Blocker
Atropine if bradycardic
In resistent cases, glucagon

10) ETHYLENE GLYCOL
1st - Fomepizole (inhibitor of alcohol dehydrogenase)
2nd - Ethanol (competes with ethylene glycol for enzyme alcohol dehydrogenase)
Haemodialysis in refractory cases

11) METHANOL POISONING
Fomepizole or ethanol
Haemodialysis

12) ORGANOPHOSPHATE INSECTICIDES
Atropine

13) DIGOXIN
Digoxin specific antibody fragments

14) IRON
Desferrioxamine (chelating agent)

15) LEAD
Dimercaprol, calcium edetate

16) CARBON MONOXIDE
100% o2
hyperbaric o2

17) CYANIDE
Hydroxocobalamin
Combination of amyl nitrite, sodium nitrite, sodium thiosulfate.