NDH - MAA Cas

Question 1

What IV agent to use in acute HPT emergency?

Answer 1

Labetolol 10 mg IVI stat

Question 2

When is tridil infusion used?

Answer 2

HPT emergency with chest pain:

Causes vasodilation of coronary arteries

Question 3

What AED to write up patient with new onset seizures?

Answer 3

Epilim 300 mg BD

+ folate

Question 4

How to load a patient when having seizures?

Answer 4

Load with opposite drug to what they are taking chronically (if taking Epilim - load with phenytoin)

Epilim loading doses:
Smaller patient - 800 mg IVI stat
Larger patient - 1.2 g IVI stat

Question 5

How to write up tridil infusion?

Answer 5

25 mg in 200 mls N/S @ 3 mls/hr IVI

Question 6

ACS protocol (from stat to life long)

Answer 6

Stat:

1. Morphine 5 mg IMI stat
2. O2
3. TNT 5 mg S/L stat
4. ASA 300 mg PO stat
5. Plavix 300 mg PO stat
6. Atorvastatin 40 mg PO stat
7. Clexane 40 mg S/C stat

For 5 days:

1. ASA 150 mg Dly PO
2. Plavix 75 mg Dly PO
3. Atorvastatin 40 mg nocte PO
4. Clexane 1 mg/kg BD S/C

NSTEMI/STEMI

1. ASA 150 mg Dly PO for life
2. Atorvastatin 10 mg Dly PO for life
3. Plavix 75 mg Dly PO for 6 months

Question 7

Landmark for ascitic tap?

Answer 7

Left lower quadrant

2 cm supero-medial to ASIS

Question 8

CCM Mx - regimens:

Answer 8

1. Ampho B 1 mg/kg/day IVI x 1/52
2. 5-FC 100 mg/kg/day in 4 divided doses
3. Fluconazole 1200 mg/day PO x 1/52

If 5-FC is not available:

1. Ampho B 1 mg/kg/day IVI x 2/52
2. Fluconazole 1200 mg/day PO x 1/52

Then:

1. Fluconazole 800 mg Dly PO x 8/52
2. Fluconazole 200 mg Dly PO for minimum 1 year
3. Stop when patient has at least 1 CD4 > 200 & VL suppression

Question 9

What Rx to start new Dx HPT/DM patient presenting with severe HPT/HPT emergency?

Answer 9

1. HCTZ 12.5 mg Dly
2. Enalapril 10 mg BD
3. Amloc 10 mg Dly
4. ASA 150 mg Dly
5. Zocor 10 mg nocte
6. Metformin 500 mg BD

Question 10

Liver supportive Rx for jaundiced patient:

Answer 10

1. Rocephin 1 g BD IVI
2. Flagyl 400 mg TDS PO
3. Lactulose 10 mls TDS
4. Thiamine 100 mg Dly IVI
5. Vit BCo 1T Dly
6. Cetirizine 10 mg nocte PO
7. GR monitoring 4 hourly
8. Vit K 10 mg Dly IVI (if deranged INR)
9. 5% dextrose 1L TDS

Sx relief:

7. Maxalon
8. Buscopan

Question 11

DKA protocol:

Answer 11

Fluids:
1. 1 L N/S IVI stat
2. 1 L N/S IVI over 2 hrs 
3. 1 L N/S IVI over 4 hrs 
4. Maintenance: 1 L N/S IVI 6 hrly 
If GR > 15 - continue N/S
If GR < 15 - switch to 5% dextrose 
If raised Na/Cl - switch to 0.45% N/S

Actrapid infusion:
1. 200 IU in 200 mls N/S IVI
2. Start at 0.1 IU/kg/hr
3. Check GR hrly & adjust accordingly to sliding scale:
0-5: give 50 mls of 50% dextrose IVI + reduce infusion by 1 ml/hr
5-10: reduce infusion by 1 ml/hr
10-15: nil
15-20: increased infusion by 1 ml/hr
> 20: give 10 IU Actrapid bolus IVI stat + increase infusion by 1 ml/hr

K:

1. K > 5.5: No KCl
2. K 3.5 - 5.5: Give 1 amp KCl in 1 litre of IVF
3. K < 3.5: Give 2 amps KCl in each litre of IVF

Monitoring:

1. 1 hrly GR monitoring
2. 6 hrly VBG + U&E
3. 12 hrly dipstick

Question 12

Depression Sx:

Answer 12

SIG-E-CAPS

Sleep changes - insomnia, hypersomnia
Interest loss - anhedonia
Guilt/ low self-esteem

Energy level - LOE/ fatigue

Concentration - poor
Appetite changes - LOA
Psychomotor changes - agitation/ slow
Suicidal ideation

Question 13

MSE components

Answer 13

ASEPTIC

Appearance/ behaviour 
Speech 
Emotion - mood/ affect 
Perceptions - auditory/ visual 
Thought content - suicidal/ homicidal ideation 
Insight & judgement 
Cognition

Question 14

When is DKA resolved?

Answer 14

1. pH > 7.35
2. No ketonuria
3. HCO3 > 19

Question 15

Dx of DKA:

Answer 15

1. GR > 11
2. 2+ ketonuria
3. pH < 7.30
4. HCO3 < 18