Placement (additional things)

Question 1

why might you prefer to use colchicine instead of NSAIDs for management of acute gout

Answer 1

NSIADs have a risk of kidney damage and PUD and fluid retention
Colchicine does not

Question 2

What is a side effect of colchicine

Answer 2

diarrhoea

Question 3

what should you always do after having a discussion with a patient / their family

Answer 3

document in the notes

Question 4

if you put an NG tube in, will it stay in that position until it is taken out?

Answer 4

No, patients may pull/twist at it which can cause it to come out of position
coughing can also do this
A bridal clip at the nose can try to hold it in place

Question 5

In a palliative patient, if you remove the NG tube, how long could they last without:
food
water (what is a consequence)

Answer 5

food - 7-8weeks
water - 24 hours
Without water, the patient could go into uraemia which is a peaceful death

Question 6

how can you administer anticonvulsant drugs to the elderly if they have a compromised swallow

Answer 6

IV e.g. valproate
SC e.g. midazolam (this will make the patient sleepy and out of it)
PR (unpleasant)

Question 7

what are the minimum and maximum amounts of time you can have a valid AWI form

Answer 7

Min - 1 month
Max - 36 months
(can NOT put it for indefinitely)
Must reassess when appropriate

Question 8

what is SIADH

Answer 8

syndrome of inappropriate ADH release

Question 9

causes of SIADH

Answer 9

Malignancy - SCLC, RCC, gastric 
Drugs - diuretics, antidepressants, anticonvulsants, PPIs
Intracranial pathology - stroke, SAH
Infection - pneumonia, UTI, meningitis 
Hypothyroidism

Question 10

symptoms and signs of SIADH

Answer 10

N+V, headache, lethargy 
oedema, ^JVP, ascites
hyponatraemia
high urinary osmolality and sodium 
small volume concentrated urine

Question 11

management of SIADH

Answer 11

identify and reverse causes
drug review
fluid restriction
vaptans, domeclocycline

Question 12

what is non-ketotic hyperglycaemic hemiballismus

Answer 12

extremely rare condition where hyperglycaemia causes oedema around the basal ganglia causing the patient to throw their arms (hemiballism)

Question 13

what is antisynthetase syndrome

Answer 13

rare chronic autoimmune inflammatory muscle disease related to poly/dermatomyositis
you get: fever, myositis, arthritis, ILD, Raynaud’s

Question 14

what is frailty

Answer 14

loss of physiological reserve and increased vulnerability to stresses

Question 15

do you treat hypertension aggressively in the elderly

Answer 15

no
in the elderly, it is difficult to say what is normal for them
medications may make them more prone to hypotension and increase falls risk

Question 16

what are sodium bicarbonate drops used for and why are they effective

Answer 16

ear wax

it unblocks and dissolves wax

Question 17

what is important to think about before inserting an NG tube

Answer 17

exit plan

what are the actual benefits of this intervention and when will it be removed (inevitable)

Question 18

what group of antibiotics should you avoid prescribing if someone is on a statin

Answer 18

macrolides

Question 19

side effect of PPIs

Answer 19

hyponatraemia
c.diff risk
osteoporosis

Question 20

Can you discharge someone with an NG tube to the community

Answer 20

NO

NG tubes need radiological surveillance and cannot be managed in the community