Planning management

Question 1

what are some adverse features of a tachycardia? and what do you do in that case?

Answer 1

shock
syncope
MI
HF

*synchronised DC shock

Question 2

what are some examples of irregular broad complex QRS tachy?

Answer 2

AF with BBB
pre-excitation AF
Torsades

Question 3

how do you manage torsades?

Answer 3

magnesium 2g over 10 min

Question 4

what is a broad QRS regular tachy?

Answer 4

ventricular tachy - amiodarone
SVT with BBB

Question 5

what are some examples of narrow QRS tachys?

Answer 5

regular - SVT
irregular - AF

Question 6

how do you determine if you should treat pneumothorax or not?

Answer 6

secondary with lung disease always treat
- chest drain >2cm
- or if over 50, SOB, <2cm aspirate

primary
- <2cm and not SOB discharge with f/u 4w
- >2cm OR SOB then aspirate and if unsuccessful attempt again and then chest drain if unsuccessful again

tension - emergency mx then drain

Question 7

what does CURB65 stand for?

Answer 7

Confusion
Urea >7.5
RR >30
Bp <90 systolic
65+ age

Question 8

how do you interpret CURB65?

Answer 8

none - home tx
2+ hospital tx with oral or IV abx
3+ ITU

Question 9

what are the 8 C’s of managing GI bleed?

Answer 9

cannulae
catheter and fluid monitoring
crystalloid bolus
crossmatching 6u
clotting abnormalities correcting
camera - endoscopy
culprit drugs stopping - NSAIDs, aspirin, warfarin, heparin
Call surgeons

Question 10

how are you managing a seizure before medications are indicated?

Answer 10

ensure airway patency
recovery position with oxygen to prevent aspiration
perform bedside tests for triggers: blood glucose, electrolytes, drugs, sepsis

Question 11

how is osmolality calculated?

Answer 11

(2xNa + 2xK) + urea + glucose

Question 12

what target blood pressures are you aiming for with antihypertensives?

Answer 12

<80 patients aim for <140/90 for clinic and <135/85 at home

over 80 add 10mmHg to systolic values

Question 13

what medications are added to CHF patient to help with mortality etc?

Answer 13

ACEI
BB
spironolactone if needed
nitrates if needed

Question 14

what does CHA2DS2-VASc stand for?

Answer 14

stroke risk!

Ccf or LHF
Hon
Age >75 (2 points)
Dm
Stroke or TIA (2 points)
Vascular disease (PAD or IHD)
Age 65-74
Sex (female)

Question 15

how do you interpret CHA2DS2-VASc scores?

Answer 15

0 - not require
1 - consider in men
2 or more - consider anticoagulant in men and women

Question 16

what is HAS-BLED score?

Answer 16

risk of anticoagulation in AF

Htn - uncontrolled BP
Abnormal renal function and liver function
Stroke

Bleeding tendency or predisposition
Labile INR
Elderly >65
Drugs like aspirin or NSAIDs

Question 17

how is HAS-BLED interpreted?

Answer 17

0 - low risk, consider anticoagulant
1-2 - moderate so consider
3< - high risk, consider alternatives to anticoagulants

Question 18

In AF who is considered for rhythm control?

Answer 18

<48h since onset, young, symptomatic, first episode or due to precipitant

*cardioversion or pharmacological

Question 19

who is considered for rate control in AF?

Answer 19

> 48h presentation

Question 20

what are the aims of angina management?

Answer 20

GTN spray for sx relief
secondary prevention
anti-anginal drug - BB or CCB

Question 21

What are some contraindication for BB?

Answer 21

hypotension
bradycardia
asthma
acute HF

Question 22

what are some contraindications for CCB?

Answer 22

hypotension
bradycardia
peripheral oedema

Question 23

what does diabetic annual review include? and why?

Answer 23

albumin-creatinine ratio
- early indicator of diabetic neuropathy, CVS disease predictor indicating need for ACEi

Question 24

first line for Parkinson’s?

Answer 24

co-careldopa or co-beneldopa

very mild - dopamine agonists

Question 25

first line: myoclonic seizures?

Answer 25

valproate male levetiracetam female

Question 26

first line: tonic?

Answer 26

valproate male lamotrigine female

Question 27

first line: focal?

Answer 27

carbamazepine or lamotrigine

Question 28

first line: absence?

Answer 28

ethosuximide or valproate

Question 29

first line: generalised tonic clonic?

Answer 29

valproate male lamotrigine female

Question 30

how are you inducing remission if crohns?

Answer 30

mild flare - prednisolone 20-40mg oral severe - hydrocortisone IV

Question 31

how is crohns remission maintained?

Answer 31

azathioprine or 6-mercaptopurine CHECK TPMT and if low start lower dose, if absent methotrexate

Question 32

what are some stool softeners?

Answer 32

docusate sodium - good for impaction, reduced gut motility

Question 33

what are some bulking agent?

Answer 33

isphagula husk - can take days and not in impaction!

Question 34

stimulant laxatives?

Answer 34

Senna and bisacodyl not in acute abdomen, may exacerbate cramps

Question 35

osmotic laxatives?

Answer 35

lactulose, phosphate enema enema not in acute abdomen, may exacerbate bloating

Question 36

RA during flare?

Answer 36

short term glucocorticoids IM methylpred short term NSAIDs with PPI DMARD restart after