number related things to learn

Question 1

ABPI measurements and interpretation

Answer 1

> 1.3: stenosis
1.0-1.3: normal
0.9-0.99: probable PAD
<0.9: PAD
< 0.5: severe and limb threatening ischaemia

Question 2

abdominal aorta screening programme

Answer 2

3.0-4.4cm: annual ultrasound
4.5-5.4cm: 3 monthly ultrasound
>5.5cm: consider surgery or 3 monthly ultrasound

Question 3

opioids in CKD

Answer 3

no renal impairment: morphine (more is fine)

mild-to-moderate renal impairment: oxycodone (we can condone oxycodone)

severe renal impairment: fentanyl, alfentanil, buprenorphine (fentaNIL, alfentaNIL, bupreNOrphine)

Question 4

transdermal fentanyl patch 12mg? oral morphine equivalent

Answer 4

30mg

Question 5

transdermal 20mg buprenorphine patch. oral morphine equivalent?

Answer 5

24mg

Question 6

when increasing dose of morphine, it must be by…?

Answer 6

30-50%

Question 7

stage 1 hypertension

Answer 7

clinic reading > 140/90
ABPM > 135/85

Question 8

stage 2 hypertension

Answer 8

clinic: >160/100
ABPM: > 150/95

Question 9

stage 3 hypertension

Answer 9

clinic > 180/120

Question 10

major bleed on warfarin

Answer 10

stop warfarin, give IV Vit K 5mg & prothrombin concentrate complex or 2nd line, fresh frozen plasma

Question 11

INR > 8.0 & minor bleeding

Answer 11

stop warfarin, give IV Vit K & recheck INR after 24 hours and give another dose.
restart warfarin at < 5.0

Question 12

INR > 8.0 and no bleeding

Answer 12

stop warfarin, give oral vit K and another dose after 24 hours if INR too high
restart warfarin when INR < 5.0

Question 13

INR 5.0-8.0, minor bleeding

Answer 13

stop warfarin, recheck after 24 hours and give another dose if needed. restart at <5.0

Question 14

INR 5.0-8.0, no bleeding

Answer 14

skip 1-2 warfarin doses, reduce subsequent maintenance dose

Question 15

CSF opening pressure

Answer 15

10-18cm H2O if lying on side; 20-30cm H20 when sat up

Question 16

routine maintenance IV fluids

Answer 16

• 25–30 ml/kg/day of water and
  approximately 1 mmol/kg/day of potassium, sodium and chloride
  and
  approximately 50–100 g/day of glucose to limit starvation
  ketosis

HOWEVER

Consider prescribing less fluid (for example, 20 to 25 ml/kg/day fluid) for patients
who:
* are older or frail
* have renal impairment or cardiac failure
* are malnourished and at risk of refeeding syndrome

Question 17

discharge criteria for pneumonia

Answer 17

NICE recommend that patients are not routinely discharged in the past 24 hours if they have had 2 or more of the following findings:
* T > 37.5
* RR > 24
* HR > 100
* BP systolic < 90
* O2 < 90 on RA
* Abnormal mental status
Inability to eat without assistance

Question 18

interpretation or CRB-65

Answer 18

0: discharge with oral Abx
1-2: consider admission
3-4: urgent admission

Question 19

CURB-65

Answer 19

confusion
urea > 7
rr > 30
bp < 90/60
65 (aged over 65)

Question 20

CURB-65 interpretation

Answer 20

0 or 1: home based care
>2: intermediate risk
>3: consider ITU assessment

Question 21

COPD severity

Answer 21

Question 22

Long term oxygen therapy indications COPD

Answer 22

Offer LTOT to patients with a pO2 of < 7.3 kPa

to those with a pO2 of 7.3 - 8 kPa and one of the following:

secondary polycythaemia
peripheral oedema
pulmonary hypertension

Question 23

serum osmolality equation

Answer 23

Serum Osmolality = 2(Na) + Urea + Glucose

Question 24

Hyperosmolar hyperglycaemic state criteria

Answer 24

This patient, therefore, fulfils the three main criteria that are often quoted in the diagnosis of HHS:

1. Marked Hyperglycaemia (> 30 mmol/L) without significant ketonaemia
2. Raised Serum Osmolality (> 320 mOsmol/kg)

3. Hypovolaemia

Question 25

pre-diabetes

Answer 25

Pre-diabetes
* HbA1c of 42-47mmol/L
Fasting plasma glucose 6.1-6.9mmol/L