Planning Management

Question 1

Give the management of a STEMI

Answer 1

Morphine 5-10mg with 50mg cyclizine IV
o2 of hypoxic
GTN
Aspirin 300mg
b blocker
PCI or thrombolysis

Question 2

How is an NSTEMI treated differently to a STEMI

Answer 2

Clopidogrel and LMWH/fondaparinux should be used instead of PCI

Question 3

How to manage tachycardia with adverse features such as: shock, syncope, ischaemia and or HF

Answer 3

Synchronized DC shock up to 3 times
- amiodarone 300mg IV over 10-20mins
- repeat shock
- amiodarone 900mg over 24hr

Question 4

How to treat ventricular tachycardia (broad complex tachycardia)

Answer 4

• amiodarone 300mg iv over 20-60min
• amiodarone infusion 900mg over 24 hr

Question 5

How to treat a polymorphic VT (torsades)

Answer 5

Give magnesium 2g over 10 minutes

Question 5

How is an irregular narrow complex tachycardia (fast AF) managed

Answer 5

b blocker or verapamil
consider digoxin or amiodarone in instance of HF symptoms

Question 6

How to manage SVT

Answer 6

• vagal manouveres
• adenosine 6mg rapid IV bolud
• adenosine 12mg
• adenosine 12mg

Question 7

Give the anaphlyaxis treatment algorhytm

Answer 7

• A-E
• remove trigger and lie patient either flat, sitting or left lateral debiscus for preg
• adrenaline 1:1000 IM ant lateral thigh
• high flow o2
• repeat adrenaline IM after 5 min if no response and give IV fluid bolus

in refractory anaphylaxis give rapid IV bolus and start an adrenaline infusion

Question 8

Give the management for an acute exacerbation of asthma

Answer 8

O2 100% non re-breathe mask
Salbutamol neb 5mg
Hydrocortisone 100mg IV for life treatening
Prednisalone 40-50mg oral for moderate
Ipatroprium bromide (500mcg neb)
Theophyline
Magnesium sulfate

Question 9

Give guidance of pneumothorax management

Answer 9

Primary
- <2cm discharge pt
- >2cm aspirate (if unsuccesful twice then drain)

Secondary
- <1cm admit and observe with o2
- 1-2cm aspiration and admit
- SOB or >2cm chest drain and admit

Question 10

Give the treatment algorithm for pneumoni

Answer 10

CURB-65 of 1 or less = home treatment
> 2 = hospital treatment
> 3 = ITU

Question 11

What drug is used to treat PE

Answer 11

DOAC

Question 12

Give drug management for bacterial meningitis

Answer 12

IV fluids
4-10mg dex (unless imminuocomprimised)
2g cefotaxime IV
2g ampicilin to be added if immunocomprimised or over 55

Question 13

Give the drug management for seizures and status epilepticus

Answer 13

Give IV benzo (midaz, diaz or loraz) 2-4mg IV, 10mg if buccal
If still fitting in 5 mins repeat
If still fitting for further 5 mins give phenytoin 15-20mg/kg iv
If further - intubate and propofol

Question 14

Give management of DKA

Answer 14

1L saline stat, then 1l over 1, 2, 4 and 8 hours.
Fixed rate insulin e.g actapid in 50ml 0.9%saline at 0.1units/kg/hr

If k+ is 4-5.5 ad 20mmol of KCl
If k+ is <4 add 40mmol KCl

Question 15

Give the anetdote for paracetamol, opiates and benzos

Answer 15

NAC, naloxone, flumazenil

Question 16

Give drug management for HTN

Answer 16

if T2DM, <55 and not black
- start w ace or arb

black, >55,
- start with CCB

then add the others
add thiazide like
give spironalactone if blood potassium is under 4.5
give a/b blocker if potassium is higher

Question 17

In what time frame should rhythm control drugs be given to patients who are young/symptomatic/first episode of AF

Answer 17

<48 hrs

Question 18

Give the drug pathway for asthma medications

Answer 18

1. SABA e.g salbutamol
2. SABA + ICS
3. SABA + ICS + LTRA (montelukast)
4. SABA + ICS + LABA (salteremol)

Question 19

Give drug pathway for COPD

Answer 19

1. Short acting b2 agonist or short acting antimuscarnic
   Salbutamol/terbutaline and ipatroprium bromide respectively

2.
- non asthmatic/non steroid responsive = LAMA and LABA
- asthmatic/steroid responsive = LABA and ICS

Question 20

How should a mild flare of chrohns be managed and a severe flare

Answer 20

mild: 20-40mg pred
severe: 100-500mg hydrocort

Question 21

Which drug should be used for insomnia

Answer 21

zopiclone

Question 22

What drugs should be used in an ACUTE flare of gout, and which drugs should be used for long-term management of gout

Answer 22

Acute:
Oral corticosteroids, NSAIDs, colchicine

Chronic: Allopurinol, febuxostat