Planning management

Question 1

Doses in STEMI/ NSTEMI / acute LVF:

a) aspirin
b) clopidogrel
c) morphine
d) beta blocker
e) furosemide
f) metoclopramide

Answer 1

a) 300mg chewed/dispersed
b) 300mg oral
c) 5-10mg IV
d) atenolol 5mg (unless asthma/LVF)
e) 40-80mg IV
f) 10mg IV

Question 2

What drug is used if there is an inadequate response to furosemide in LVF?

Answer 2

Isosorbide dinitrate

Question 3

What is the a) first line treatment b) second line treatment, if there are adverse features in adult tachycardia (i.e. shock, syncope, MI, heart failure)

Answer 3

a) Synchronized DC shock (up to 3 attempts)

b) amiodarone 300mg IV over 10-20 minutes, followed by amiodarone infusion

Question 4

Tachycardia with narrow QRS and irregular rhythm?

Answer 4

Probably fast AF

Question 5

Tachycardia with narrow QRS and regular rhythm?

Answer 5

Probable re-entry paroxysmal SVT

Question 6

Drug management of a) atrial fibrillation b) re-entry paroxysmal SVT

Answer 6

a) beta-blocker or diltiazem; digoxin/amiodarone if evidence of heart failure
b) vagal manouvres; adenosine 6mg IV (then 12mg, then 12mg)

Question 7

Drug doses in anaphylaxis:

a) adrenaline
b) chlorphenamine
c) hydrocortisone

Answer 7

a) 500 micrograms of 1:1000 IM
b) 10mg IV
c) 200mg IV

Question 8

CURB-65 score?

Answer 8

Confusion 
Urea > 7.5
Respiratory rate > 30
Blood pressure < 90
Over 65 years of age

Question 9

CURB score for a) mild b) moderate c) severe CAP?

Answer 9

a) 0-1 b) 2 c) 3 or greater

Question 10

Antibiotic choices for a) mild/moderate b) severe CAP?

Answer 10

a) oral/IV amoxicillin/doxycycline if pen-allergic, 5 days therapy
b) co-amoxiclav IV + doxycycline PO, 7 days therapy

Question 11

GI haemorrhage treatment:

a) if prolonged PT/aPTT more than 1.5x normal range
b) if prolonged PT/aPTT due to warfarin
c) if thrombocytopenia (<50x10^9) and actively bleeding

Answer 11

a) fresh frozen plasma
b) prothrombin complex (i.e. beriplex)
c) platelet transfusion

Question 12

Management of suspected bacterial meningitis (3)

Answer 12

Ceftriaxone 2g IV + Dexamethasone 10mg + Amoxicillin 2g IV if old or immunocompromised

Question 13

Complications of AKI? (3)

Answer 13

Fluid overload, hyperkalaemia, acidosis

Question 14

Management of DKA/HONK? (3)

Answer 14

IV fluids, sliding scale insulin, monitor BM potassium and pH

Question 15

When do NICE recommend starting treatment for hypertension?

Answer 15

If BP >180/95, or 135/85 if existing vascular disease or hypertensive organ damage

Question 16

NICE treatment algorithm for hypertension?
Step 1
Step 2
Step 3
Step 4

Answer 16

Step 1- if under 55 years, ACE inhibitor or ARB. If over 55, or black patients of any age, Calcium channel blocker

Step 2- A + C

Step 3- A + C + D (thiazide Diuretic)

Step 4- A + C + D plus either alpha blocker, beta blocker, further diuretic

Question 17

CHADSVASC score interpretation? (3)

Answer 17

0- aspirin 75mg daily
1- aspirin or wafarin
2 or more- warfarin

Question 18

Rate control in Atrial fibrillation? (3)

Answer 18

Beta blocker or rate limiting calcium blocker. Digoxin if required or beta-blockers/calcium blockers contraindicated

Question 19

First line stable angina management? (3)

Answer 19

GTN spray as required
Secondary prevention - aspirin, statin, hypertension treatment
Beta-blocker/calcium blocker

Question 20

What is used in stable angina if beta blocker/calcium blocker (either as mono- or dual therapy) fails to control symptoms?

Answer 20

Monotherapy with either nicorandil or long acting nitrate (e.g. isosorbide mononitrate)

Question 21

Asthma management guidelines?
Step 1
Step 2
Step 3
Step 4
Step 5

Answer 21

1- SABA as required
2- SABA + inhaled steroid
3- initial add-on therapy. Add LABA. If no response/inadequate response to LABA, increase steroid. If no response to LABA consider other therapies e.g. leukotriene antagonist
4- Consider increasing inhaled steroid, addition of a fourth drug e.g. B2 agonist tablet
5- add daily steroid tablet

Question 22

First-line treatment for Parkinsons?

a) normal circumstances
b) mild Parkinsons where patient is concerned about the finite period of benefit from levodopa

Answer 22

a) Co-beneldopa or co-careldopa (i.e. levodopa combined with peripheral decarboxylase inhibitor)
b) dopamine agonist e.g. ropinirole

Question 23

Treatment options for constipation: examples of

a) stool softener
b) bulking agent
c) stimulant (2)
d) osmotic (2)

Answer 23

a) docusate sodium
b) isphaghula husk
c) senna, bisacodyl
d) lactulose, phosphate enema

Question 24

In the case of faecal impaction, what laxative would be useful and what would be contraindicated?

Answer 24

Docusate is useful as it is a stool softener; ispaghula is contraindicated as it is a bulking agent

Question 25

Treatment of chronic non-infective diarrhoea?

Answer 25

Loperamide 2mg oral up to 3hrly

Codeine 30mg oral up to 6 hourly

Question 26

Choice of hypnotic agent?

Answer 26

Zopiclone

Question 27

What is hydroxocobalamin used to treat?

Answer 27

B12 deficiency

Question 28

First-line potassium-lowering therapy in hyperkalaemia?

Answer 28

10 units of actrapid/novorapid in 50ml of 50% glucose over 15 minutes

Question 29

Which anti-epileptic has the best safety profile in pregnancy?

Answer 29

Lamotrigine

Question 30

Which anti-epileptic is best for focal seizures?

Answer 30

Carbamazapine

Question 31

What is the second-line treatment for absence seizures if sodium valproate is not tolerated/contraindicated?

Answer 31

Sodium valproate

Question 32

Side-effects of:

a) lamotrigine
b) sodium valproate

Answer 32

a) rash, rarely SJS

b) tremor, teratogenic, tubby

Question 33

When is metformin avoided?

Answer 33

Elevated creatinine- risk of lactic acidosis