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PSA > Planning management > Flashcards

Planning management Flashcards

1
Q

Acute management of a STEMI.

A 
ABCDE + 15L high flow oxygen.
Aspirin 300mg oral.
Morphine with metoclopramide.
GTN spray/tablet.
PCI or thrombolysis.
Beta-blocker.
Transfer to CCU.
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2
Q

Acute management of NSTEMI.

A 
ABCDE + 15L high flow oxygen.
Aspirin 300mg oral.
Morphine with metoclopramide.
GTN spray/tablet.
Clopidogrel 300mg oral or LMWH (enoxaparin).
Beta-blocker.
Transfer to CCU.
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3
Q

Acute LVF.

A 
ABCDE + 15L high flow oxygen.
Sit the patient up.
Morphine with metoclopramide.
GTN spray/tablet.
Furosemide 40-80mg IV.
If inadequate response, isosorbide dinitrate infusion with CPAP.
Transfer to CCU.
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4
Q

Anaphylaxis.

A 
ABCDE + 15L high flow oxygen.
Remove cause of anaphylaxis.
Adrenaline 1:1000 IM.
Chlorphenamine 10mg IV.
Hydrocortisone 200mg IV.
If asthmatic and wheezey give inhaler.
Amend drug chart allergy box.
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5
Q

Acute asthma exacerbation.

A 
100% O2 rebreather mask.
Salbutamol 5mg nebulised.
Hydrocortisone 100mg IV (severe or life threatening).
Ipatropium 500micrograms nebulised.
Magnesium sulphate.
Theophylline.

Steroid treatment for 5 days post attack (prednisolone).

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6
Q

Acute COPD exacerbation.

A 
28% O2 rebreather mask.
Salbutamol 5mg nebulised.
Hydrocortisone 100mg IV (severe or life threatening).
Ipatropium 500micrograms nebulised.
Magnesium sulphate.
Theophylline.

Add in a antibiotics if believed to be infectious exacerbation.

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7
Q

Types of pneumothorax.

A

Primary – no underlying lung disease.
Secondary – underlying lung disease.
Tension – tracheal deviation +/- shock.

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8
Q

Treating pneumothorax.

A

Primary – treat if SOB or rim is >2cm on CXR. Aspirate.
Secondary – always treat. Chest drain if SOB/>2cm/>50yo.
Tension – aspirate immediately then insert chest drain.

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9
Q

Acute management GI bleed.

A 
ABC
High flow oxygen.
2 large bore cannulaes.
Catheter and fluid restriction: give crystalloid/colloid fluid.
Cross match 6 Units blood.
Correct clotting abnormalities.
Stop any medication causing bleeding.
Consult with surgeon if severe.
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10
Q

Acute management bacterial meningitis.

A 
ABC.
High flow oxygen.
IV fluid and dexamethasone.
LP (+/- CT head). Treat with abx before if going to be delayed.
2g cefotaxime IV.
Consider ITU.
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11
Q

Acute management of seizure/status epilepticus.

A

ABC.
Put patient in recovery position with oxygen.
If >5 mins: 2-4mg Lorazepam IV, or diazepam/midazolam.
If continuing after 2 mins, repeat medication.
Contact anaesthetist.
Phenytoin infusion.
Intubate then propofol.

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12
Q

Acute management ischaemic stroke.

A

ABC.
If <80 and <4.5 hours since onset consider thrombolysis.
Aspirin 300mg oral.
Transfer to stroke unit.

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13
Q

Acute management DKA.

A

ABC.
IV fluid: 1L stat then1L over 2h then 4h then 8h.
Sliding scale insulin (check potassium levels).
Find cause: infection, MI, missed insulin.
Monitor BM, K+ and pH.

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14
Q

DKA criteria.

A

Hyperglycaemia (>30mmol/L)
Ketones.
Acidic pH.

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15
Q

Acute management of HONK.

A 
ABC.
IV fluid: 500ml stat, then over 2h, 4h and 8h.
Sliding scale insulin.
Find cause.
Monitor BM, K+ and pH.
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16
Q

Management of acute poisoning.

A 
ABC.
Cannula and catheter, strict fluid management.
Correct electrolyte imbalances.
Reduce absorption.
Increase elimination.
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17
Q

What can you give in paracetamol OD?

A

N-Acetyl Cystine, if within the treatment block on normogram.

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18
Q

What can you give in opiod OD?

A

Naloxone.

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19
Q

What can you give in benzodiazepine OD?

A

Flumazenil.

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20
Q

When do you treat hypertension?

A

BP >150/95, or

BP >135/85 if existing or risk of vascular disease or hypertensive organ damage.

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21
Q

Hypertension medication for <55yo not of African-Caribbean descent.

A

ACEi.
Calcium channel blockers.
Thiazide-like diuretic.

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22
Q

When does hypertension become resistant and what do you then do?

A

If it is still uncontrolled despite adding thiazide-like diuretic to previous anti-hypertensives. Refer to a specialist for addition of further medication.

23
Q

Hypertension medication >55 or African-Caribbean descent.

A

Calcium channel blocker.
ACEi.
Thiazide-like diuretic.

24
Q

Target blood pressures when on anti-hypertensive medication.

A

Clinic: 140/85
Home measuring: 135/85

If over 80, add 10 to the systolic values.

25
Q

Medications used in the management of chronic heart failure (in order of addition).

A

ACEi and beta blocker (lisinopril and bisoprolol) daily.
Increase doses to max if ineffective. Then,
Mild-moderate + angiotensin receptor blocker.
Moderate-severe (Afri-Cari) + hydralazine and isosorbide mononitrate.
Moderate-severe (others) + spironolactone.

26
Q

AF treatment based on cha2ds2-vasC score.

A

0 – aspirin 300mg daily.
1 – aspirin/warfarin aiming for INR of 2.5.
2 – warfarin aiming for INR of 2.5.

27
Q

In which AF patients do you aim for rhythm control and how.

A

Young/symptomatic/first episode/due to precipitant.

Cardioversion: electrical or using amiodarone. Patient will require anticoagulation.

28
Q

When can cardioversion not be given and why.

A

When AF has been present for over 48 hours due to the risk of dislodging a clot.

29
Q

How is rate controlled in AF.

A

Propanolol (10mg 6-hourly) or rate limiting calcium channel blocker (diltiazem).
Add digoxin if still uncontrolled (first line if others are contraindicated).

30
Q

Investigations to distinguish stable angina from acute coronary syndrome.

A

ECG – if no changes then stable angina.
Troponin – raised=STEMI/NSTEMI; normal = assess ECG.
12h troponin – use to exclude NSTEMI.

31
Q

First line management of stable angina.

A

GTN spray as required.
Secondary prevention: aspirin, statin and cardiovascular risk factor modification.
One anti-anginal + beta blocker/calcium channel blocker.

32
Q

Antianginal medication.

A

Nitrates – isosorbide mononitrate/dinitrate.

Calcium antagonists – diltiazem, verapamil, nifedipine.

33
Q

How to treat persistent stable angina.

A

Increase dose of beta/calcium channel blocker as tolerated.
Add new antanginal. Add the other blocker if not CI.
Add long acting nitrate, or potassium channel activator.

If uncontrolled on two antianginals then refer for urgent revascularisation (PCI) therapy or CABG

34
Q

Stepwise chronic asthma treatment.

A

SABA as required throughout.

– Inhaled corticosteroid (ICS).
+ LABA.
Then: If responding to LABA, increase ICS dose to medium.
– Consider addition of: LTRA, SR theophylline, LAMA.
– Increase ICS dose to high.

35
Q

Stepwise medication addition in COPD patients with persistent breathlessness/exacerbation FEV1 >50%.

A

+LABA–> +ICS –>+LAMA. Or,

+LAMA–>+LABA + ICS.

36
Q

Stepwise medication addition in COPD patients with persistent breathlessness/exacerbation FEV1 <50%.

A

LABA+ICS/LAMA–>LABA+ICS+LAMA.

37
Q

Four components of diabetes treatment (both types).

A

Patient education.
CV risk management.
Annual review of complications.
Blood glucose lowering therapy.

38
Q

How is CV risk managed in diabetes.

A

If risk factors:
75mg Aspirin daily (or if >50yo in T2DM).
20-40mg Simvastatin (or if >40 in T2DM).

39
Q

What is checked at a diabetes annual review, and what does it measure.

A

Albumin-creatinine ratio (ACR): indicator of diabetic neuropathy and predictor of CV disease.

ACR >3mg/mmol needs treating with and ACEi.

40
Q

Blood glucose lowering therapy in T1DM.

A

Insulin.

Never give hypoglycaemic medications.

41
Q

Blood glucose lowering therapy in T2DM (stepwise management).

A

– Metformin 500mg with breakfast. If low/normal weight with creatinine >150micromol/L use sulphonylurea instead.
– Increase dose to maximum.
– With metformin: +sulphonylurea; with sulphonylurea + gliptin.
– Add insulin, consult with diabetologist.

42
Q

Medications to treat parkinson’s

A

Co-beneldopa.

Co-careldopa.

43
Q

Antiepileptic drugs and which seizure they’re used for.

A 
Tonic-clonic – sodium valproate.
Absence – sodium valproate/ethosuximide.
Myoclonic – sodium valproate.
Tonic – sodium valproate.
Focal – carbamazepine or lamotrigine.
44
Q

Lamotrigine side effects.

A

Rash

Rarely, Steven-Johnson syndrome.

45
Q

Carbamazepine side effects.

A 
Rash.
Dysarthria.
Nystagmus.
Ataxia.
Hyponatraemia.
46
Q

Phenytoin side effects.

A

Ataxis.
Peripheral neuropathy.
Gum hyperplasia.
Hepatotoxicity.

47
Q

Sodium valproate side effects.

A

Tremor.
Teratogenic.
Tubby (weight gain).

48
Q

Which anti-epileptic should be given in pregnancy.

A

Lamotrigine.

49
Q

Which antiepileptic do you avoid using and why.

A

Phenytoin for its narrow therapeutic index.

Only used if patient is in status epilepticus and cannot swallow.

50
Q

Licensed drugs for Alzheimers.

A

Donepezil.
Rivastigmine.
Galantamine.
Memantine – severe.

51
Q

Medication to induce remission in Crohn’s.

A

Mild flare – 30mg prednisolone daily.

Severe flare – hydrocortisone 100mg 6-hourly IV with supportive treatment.

52
Q

Medicine to maintain Crohn’s remission.

A

Azathioprine.
6-mercaptopurine.

If contraindicated (due to low TPMT) then use methotrexate.

53
Q

Long term RA treatment.

A

Methotrexate and one disease modifying antirheumatic drug (sulfasalazine or hydroxychloroquine)

54
Q

RA flare treatment.

A

Short term glucocorticosteroids (IM methylprednisolone).
Short term NSAIDS (ibuprofen with lansoprazole gastric protection)
Reinstate DMARD if dose previously reduced.

PSA (7 decks)

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