Planning Management

Question 1

Management of tachycardia with adverse features e.g. shock, syncope

Answer 1

Synchronised DC shock up to 3 attempts

Amiodarone 300mg IV over 10-20 mins
Amiodarone 900mg over 24h

Question 2

Management of tachycardia if stable

Narrow QRS
Broad QRS

Answer 2

Narrow -
Regular - vagal manoeuvres, adenosine 6mg bolus, then 12

Irregular - probable AF - beta blocker

Broad QRS -
Regular - AF, polymorphic VT

Irregular -
VT - amiodarone 300mg IV

SVT - adenosine

Question 3

Management of anaphylaxis

Answer 3

ABC, O2 by non-rebreather mask
Remove cause ASAP
Adrenaline 500mcg 1:1000

Chlorphenamine, hydrocortisone
Asthma tx if wheeze

Question 4

Management of acute exacerbation of asthma

Answer 4

100% O2, non-rebreather mask
Salbutamol 5mg NEB
Hydrocoristone 100mg IV or prednisolone 40-50mg oral
Ipratropium 500 mcg NEB

Question 5

Management of PE

Answer 5

High flow oxygen
Morphine 5-10mg IV
Cyclizine 50mg IV
LMWH
If low BP - IV fluid bolus

Question 6

Management of GI bleed

Answer 6

ABC, O2
Cannulate, catheter, IV bolus
Cross match 6 units
Correct clotting
Camera - endoscopy
Stop culprit drugs - NSAIDs, aspirin, warfarin, heparin

Question 7

Management of bacterial meningitis

Answer 7

High flow O2, IV fluid
4-10mg dexamethasone IV
LP, CT head
2g cefotaxime IV, add ampicillin >55

Question 8

Diagnosis criteria of HSS

Answer 8

Hyperosmolar hyperglycaemic state

Hyperglycaemia usually >35 mmol
Hyperosmolar - over 340mmol/l
Nonketotic

Management same as DKA except lower rates of insulin used

Question 9

Management of stroke

Answer 9

CT head exclude haemorrhage, history and examination
If onset <4.5 hrs. consider thrombolysis
Aspirin 300mg

Question 10

Management of DKA

Answer 10

IV fluid 1L saline stat
Fixed rate insulin e.g. 50 units actrapid in 50ml 0.9% saline, 0.1units/kg/hr
Look for trigger - infection, MI, missed insulin

Question 11

Management of acute poisoning

Answer 11

IV fluids and analgesia
Reduce absorption if within 1 hr by carrying out gastric lavage, bowel irrigation or charcoal

N-acetyl cysteine if paracetamol level at 4 hours or more is over the line
Naloxone - opiates
Flumazenil - benzodiazepines

Question 12

What is included in the CHA2DS2-Vasc score

Answer 12

Congestive heart failure
Hypertension
Age >75 - 2 points
Diabetes mellitus
Stroke or TIA - 2 points
Vascular disease
Age 64-75
Sex - female

Generally 0 no anticoagulation, 1 consider in men using apixaban etc
2 - men and women

Question 13

Management of stable angina

Answer 13

GTN spray as required
Secondary prevention - aspirin, statin, CV risk modification
Anti-anginal drug - beta blocker, or CCB

Question 14

Management of different types of seizures

Answer 14

Myoclonic - sodium valproate, levetiracetam

Tonic seizures - valproate, lamotrigine

Focal seizures - carbamazepine, lamotrigine

Absence seizures - ethosuximide, valproate

Generalised tonic clonic - sodium valproate, lamotrigine

Question 15

Management of Crohn’s

Answer 15

Induce remission - prednisolone or severe flare with hydrocortisone

Maintain remission - azathioprine or 6-mercaptopurine

Question 16

Common side effects of antiepileptics

Answer 16

Lamotrigine - rash, stevens-johnson
Carbamazepine - rash, dysarthria, ataxia
Phenytoin - ataxia, neuropathy, gum hyperplasia
Sodium valproate - tremor, teratogenicity, weight gain
Levetiracetam - fatigue, mood disorders

Question 17

Management of constipation

Answer 17

Stool softeners - docusate sodium
Bulking agents - isphagula husk
Stimulant - senna, bisacodyl
Osmotic - lactulose, phosphate enema

Question 18

Management of RA flare up

Answer 18

Short term glucocorticoids e.g. IM methylprednisolone 80mg
Short term NSAIDs e.g. ibuprofen and GI protection like lansoprazole
Re-instate DMARDs if dose prev reduced