Posioning

Question 1

hyperventilation, tinnitus, deafness, vasodilatation, sweating - which drug OD?

Answer 1

Aspirin

Question 2

Treatment for aspirin overdose?

Answer 2

Sodium bicarbonate, haemodialysis

Question 3

Drug OD that may require dialysis?

Answer 3

Salicylates, lithium

Question 4

Monitoring in aspirin overdose?

Answer 4

Monitor plasma-salicylate level, pH, electrolytes

Question 5

Coma, respiratory depression, pinpoint pupils - which OD?

Answer 5

Opioid

Question 6

Sx of paracetamol OD

Answer 6

Sx: N&V, RUQ pain (hepatic necrosis, worst 3-4d after overdose)

Question 7

drowsiness, ataxia, dysarthria, nystagmus (occasionally respiratory depression and coma) - which drug OD?

Answer 7

Benzodiazepine

Question 8

Treatment for benzo OD?

Answer 8

Flumazenil

Question 9

Initial treatment for TIA

Answer 9

Tx: aspirin 300mg for 2w

Question 10

Management for ischaemic stroke

Answer 10

Dx: CT then MRI with diffusion
Tx:
≤4.5h and no contraindication to thrombolysis: thrombolysis (alteplase) then aspirin 300mg for 2w
>4.5h or contraindication to thrombolysis: aspirin 300mg for 2w
Secondary prevention: clopidogrel 75mg for life

Question 11

Doses in status epilepticus

Answer 11

Buccal midazolam 10mg
IV lorazepam 0.1mg/kg

Question 12

Community tx of meningitis?

Answer 12

Benzylpenicillin or cefotaxime (give IM before urgent transfer to hospital then IV)
Sx overlap with subarachnoid haemorrhage

Question 13

Verbal response component of GCS?

Answer 13

5. Oriented
6. Confused
7. Words
8. Sounds
9. None

Question 14

Motor response of GCS?

Answer 14

6. Obeys commands
7. Localises
8. Withdraws
9. Abnormal flexion (decorticate)
10. Abnormal extension (decerebrate)
11. None

Question 15

cardiac arrest management

Answer 15

CPR 30:2 (attach defibrillator)
Assess rhythm
Shockable (VF or pulseless VT) - 1 shock
Non-shockable (PEA or asystole) - no shock
CPR 30:2 for 2m
Assess rhythm…

Adrenaline 1mg of 1:10,000 IV (repeat every 3-5m)
Amiodarone 300mg IV (after 3 shocks)
Reversible causes of cardiac arrest:
‘The H’s’ - hypoxia, hypovolaemia, hypo-/hyper-kalaemia, hypothermia
‘The T’s’ - thrombosis, tension pneumothorax, tamponade, toxins

Question 16

1, V5, V6 leads - which ACS?

Answer 16

Left circumflex artery
Lateral MI

Question 17

V1-V4 leads?

Answer 17

anterior MI (anterior/septal)
LAD

Question 18

II, III, avF - which MI and which artery is affected?

Answer 18

Inferior MI
Right coronary artery (RCA)

Question 19

Seconary prevention - ‘BADS’
ACS

Answer 19

BB - bisoprolol 2.5mg PO
ACEi - ramipril 1.25mg PO
Dual antiplatelets - aspirin 75mg and clopidogrel 75mg PO
Statin - atorvastatin 80mg PO

Question 20

Acute treatment of ACS?

Answer 20

“MONAC”
Morphine 10mg IV and metoclopramide 10mg IV
O2 if hypoxic (<94%)
Nitrates
Aspirin 300mg PO
Clopidogrel 300mg PO

Question 21

Treatment of NSTEMI

Answer 21

GRACE score
Low risk - nil
High risk - consider glycoprotein IIb/IIIa (eptifibatide or tirofiban) and coronary angiography
Fondaparinux or UH

Question 22

Narrow complex tachycardia?

Answer 22

1 vagal manouvres

#2 adenosine 6mg IV (12mg, 12mg)

Question 23

Broad complex tachycardia?

Answer 23

Regular
Amiodarone 300mg IV over 10-20 mins (then 900 mg over 24 hours)
Irregular (torsades de pointes)
Magnesium sulphate 2g IV

Question 24

Treatment of bradycardia?

Answer 24

1 atropine 500mcg IV (repeat to max 3 mg)

#2 transcutaneous pacing

Question 25

Pulmonary oedema treatment?

Answer 25

Oxygen 15L
Diamorphine 1.25-5mg IV
Furusemide 20-50mg IV
GTN

Question 26

Where does testicular cancer spread to?

Answer 26

Lateral aortic
The testes (and ovaries in women) drain to the lateral aortic nodes, also known as the para-aortic nodes. These cannot be palpated upon physical examination but can be seen on a computed tomography scan performed for staging. The presence of nodal metastasis is part of the grading of testicular cancer using the Royal Marsden staging system.

Question 27

What is guttate psoriasis?

Answer 27

Occurs after strep URTI infection
Salmon pink lesions

Question 28

Which lung cancer is associated with hypercalcaemia?

Answer 28

Squamous cell

Question 29

Subarachnoid haemorrhage tx?

Answer 29

Endovascular coiling

Question 30

Subdural haemorrhage tx?

Answer 30

burr hole drainage

Question 31

Causes of Hyperglycaemia

Answer 31

Steroids, antipsychotics, thiazides, beta blockers, tacrolimus

Question 32

o Beta blockers reversing agent?

Answer 32

Atropine (low HR), glucagon (low BP)

Question 33

Haemodialysis indicated in overdoses of BLAST drugs?

Answer 33

-Barbiturates
- Lithium
- Alcohol
- Salicylates
- Theophylline