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Rahul's Basics > Rahul's treatments > Flashcards

Rahul's treatments Flashcards

1
Q

How do you treat asymptomatic diverticulitis

A

no treatment required

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2
Q

how do you treat symptomatic diverticulitis

A

diet modification + fibre supplementation

oral antibiotics

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3
Q

How do you treat uncomplicated symptomatic diverticulitis

A

Analgesia
oral antibiotics
low residue diet

2nd line:
IV antibiotics
analgesia
low residue diet

get a colonscopy 2-6 weeks later

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4
Q

How do you treat complicated symptomatic diverticulitis with rectal bleeding?

A

endoscopic haemostatis/angiogrpahic embolisation
supportive therapy
antibiotics - amoxicillin/clavulanate: 500 mg oral tablets every 8 hours for 7 days
Analgesia
Low residue diet

2nd line: surgery

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5
Q

What is the step up management of pain?

A
  1. Paracetamol - 500 - 1000 mg oral every 4-6 hours PRN; max 4000 mg totaly
  2. Tramadol - 50-100 mg IM/IV every 4-6 hours PRN
  3. Morphine sulfate - 5-10 mg SC/IM every 4 hours PRN
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6
Q

How do you manage low risk ectopic pregnancy?

A

Expectant management

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7
Q

How do you manage moderate risk ectopic pregnancy?

A

Methotrexate
Surgery
Post-surgical methotrexate
Anti-D immunoglobulin - to prevent sensitisation

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8
Q

How do you manage ruptured ectopic pregnancy in a hemodynamically stable patient?

A

Surgery

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9
Q

How do you manage ruptured ectopic pregnancy in a haemodynamically unstable patient?

A

Fluid resuscitation

Surgery

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10
Q

How do you manage acute renal colic non-pregnant?

A

Conservative management
Hydration - crystalloid
Analgesia - NSAIDs (ketorolac) + paracetamol
Anti-emetics - Ondansetron (4mg IV every 8 hours)

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11
Q

How do you manage confirmed kidney stone?

A

H, Analgesia, anti-emetics

If bacteria in urine- antibiotics, surgical decompression

IF Stones <10mm - medical expulsive therapy: tamsulosin (alpha blocker or alfuzosin)

IF stones > 10 mm or failed med therapy -
Extracorporeal shcok wave lithotripsy
Ureteroscopic removal
Percutaneous nephrostolithotomy

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12
Q

How do you manage confirmed kidney stone with obstruction

A

Hydration, analgesia, anti-emetics

Surgical decompression using a stent to achieve drainige either via STENT or PERCUTANEOUS NEPHROSTOMY

Extracorporeal shcok wave lithotripsy
Ureteroscopic removal
Percutaneous nephrostolithotomy

IF INFECTION - Gentamicin 1.5 mg/kg IV for 8 hours

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13
Q

What is the management of pyelonephritis?

A

Antibiotics - Ciprofloxacin, Ofloxacin

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14
Q

How do you manage urinary retention?

A

Catheterization to void bladder
Set up IV fluids in advance to compensate for diuresis
Assess renal function - blood urea, creatinine, electrolytes
and monitor urine output over next 12-48 hours
Assess cause of obstruction - dip urine, refer urologist
TWOC - unless creatinine was raised

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15
Q

How does the procedure for a TWOC work?

A

Give the patient an alpha-blocker and antibiotics
Remove catheter
See if they urinate (do it at midnight or early morning)

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16
Q

What is the management for CENTRAL Diabetes Insipidus

A

For any hypernatraemia –> oral/IV fluids and make frequent estimates of electrolytes

Central with no history of pituitary trauma/surgery:
Desmopressin +oral/IV fluids

Chronic Central DI:
Desmopressin

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17
Q

What is the management for NEPHROGENIC Diabetes Insipidus?

A

Maintenance of adequate fluid intake
Treat underlying cause
Restricted sodium diet, Thiazide diuretics - HYDROCHLOROTHIAZIDE

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18
Q

How do you manage suspected MI?

A

Aspirin
Oxygen
Morphine
GTN

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19
Q

How do you manage haemodynamically unstable MI?

A 
PCI or CABG
Heparin
Aspirin + Ticagrelor (P2Y12 inhibitor)
Morphine
Oxygen (if sats <90%)
20
Q

How do you manage haemodynamically stable MI?

A 
Access to PCI within 90 minutes
PCI
Heparin
Aspirin + Ticagrelor
Beta-blocker
21
Q

How do you manage haemodynamically stable MI no access to PCI in 90 minutes, within 12 hours of symptom onset?

A 
Thrombolysis
PCI - ongoing chest pain, unstable
Enoxaparin
Aspirin + Clopidogrel
Beta-blocker (Atenolol)
Statin (Atorvastatin)
22
Q

What is the management of alcoholic hepatitis?

A

Abstinence
Address metabolic syndrome if it is present
Steroids
Possible nutritional support as alcoholics are notorious for not eating properly
Live transplant IF in failure

23
Q

What is the management of a patient with liver cirrhosis?

A

Treat the underlying cause

Consider a liver transplant

24
Q

How do you manage cholelithiasis?

A

Cholecystectomy

25
Q

How do you manage choledocholithiasis?

A

ERCP

Endoscope retrograde choleopancreatography

26
Q

Adrenal insufficiency?

A

Life long: Glucocorticoid + Mineralocorticoid
(Hydrocortisone - 2/3 in the morning, 1/3 in afternoon + Prednisolone)

Increase dosage of Glucocorticoid during periods of stress (infection, trauma, surgery)

27
Q

Addisonian crisis?

A

100 mg IV hydrocortisone
1L 0.9% NaCl over 30-60 minutes

IF Hypoglycaemic: 50ml 50% dextrose
Treat precipitating cause

100 mg IV hydrocortisone 6 hourly until stable
2-4L 0.9% NaCl over 12-24 hours
When stable convert to oral maintenance hydrocortisone

28
Q

How do you manage an ACTH secreting pituitary tumor? (Cushing Disease)

A 
Transsphenoidal pituitary adenomectomy 
Pre-surgery: 
Somatostatin analog
Steroidogenesis inhibitor  
Glucocorticoid receptor antagonist

Post-surgery: Pituitary hormone replacement therapy
Consider: Pituitary radiotherapy
If no response: bilateral adrenalectomy

29
Q

How do you manage ectopic ACTH secreting tumour?

A

Surgical resection/ablation of tumour

30
Q

How do you manage adrenal disease-causing Cushing Syndrome?

A

Resection of adrenal glands

Corticosteroid replacement if needed

31
Q

How do you manage hyperkalaemia?

A

10 ml 10% calcium gluconate - stabilise myocardium + prevent arrhythmias

100 ml 20% dextrose and 10 units of insulin

Nebulised salbutamol

Treat underlying cause

32
Q

How do you manage hypokalaemia?

A

Reduce potassium losses - discontinue diuretics/laxatives, switch to potassium-sparing diuretics, treat diarrhea and vomiting

Replenish potassium stores -
MINOR: Oral potassium replacement
SEVERE (eg. ECG changes, <2.5 mmol/L): IV potassium

Monitor for complications using continuous ECG monitoring

33
Q

What is the treatment for Hypercalcaemia?

A

Fluids
IV bisphosphonates
Haemodialysis

?Calcitonin
?Denosumab
?Cinacalcet
?Steroids
Surgery
34
Q

What is the treatment for Hypocalcaemia?

A

IV calcium gluconate 10%
Calcium chloride
?PTH
Vitamin D and supplements

35
Q

What is the treatment of Hyperparathyroidism?

A

IV fluids every 4-6 hours for a few days
Moderation of how much calcium and vitamin D the patient ends up getting

Surgery for definitive treatment

Otherwise treat patient with Bisphosphonates, Oestrogen, Cinacalcet (for parathyroid carcinoma)

36
Q

What is the treatment for alcohol withdrawal syndrome?

A

1st line is BENZODIAZEPINES (or Clormethiazole)
give oral if it is MILD
give IV if it is MODERATE to SEVERE

For seizures give Lorazepam

Eg Benzodiazepine:

Chlordiazepoxide: 50-100 mg orally every 4-6 hours until agitation is controlled, then reduce to lowest maintenance dose

or Diazepam (oral or IV)

or Lorazepam (oral or IV or IM)

37
Q

How would you manage a patient who is in anaphylaxis?

A 
ABCDE approach 
High flow oxygen 
IM adrenaline 
Chlorpheniramine (antihistamine) 
Hydrocortisone 
IF continued deterioration --> bronchodilator therapy
Monitor pulse oximetry, ECG, BP
38
Q

How would you manage infectious mononucleosis?

A

Paracetamol or Ibuprofen
Hydration
Antipyretics
NO ASPIRIN TO CHILDREN

If upper airways obstruction/haemolytic anaemia -
Corticosteroids

Thrombocytopenia-
Corticosteroids or IV immunoglobulin

39
Q

How do you manage chicken pox?

A

1st line: SUPPORTIVE CARE - paracetamol, diphenhydramine (oral + topical)

Moderate risk of severe disease:
oral antiviral therapy
supportive care

High risk of severe disease:
IV antiviral therapy
supportive care

40
Q

How do you manage herpes zoster in someone with is immunocompetent?

A

Oral antiviral therapy - famciclovir, valaciclovir

with mild pain - simple analgesic + calamine lotion

with mod-to-severe pain - opiod analgesics + topical analgesics

eye involvement - refer to the ophthalmologist

41
Q

How do you manage herpes zoster in someone who is immunocompromised?

A

No eye involvement:
Oral antiviral - famciclovir, calaciclovir
simple analgesics + calamine lotion
opioid analgesics + topical

2nd line:
IV aciclovir

Eye invovlement or disseminated:
IV aciclovir
with opiod analgesics + topical analgesia

42
Q

How do you manage a cold?

A 
Reassure the patient
Hydration
Analgesia
Antipyretics
Decongestants
Antihistamine
Antitussive

Can give paracetamol, ibuprofen

oxymetazozline nasal
ipratropium nasal

43
Q

How do you manage an uncomplicated skin or soft tissue abscess?

A

Incision and drainage

44
Q

How do you manage a severe abscess

A

Antibiotics

Incision and drainage

45
Q

How do you manage infective endocarditis?

A

Take 3 blood cultures, 1 hour apart
Perform an urgent echocardiogram
Broad spectrum antibiotics

46
Q

How do you manage Hepatitis B?

A

Symptomatic treatment for acute presentation

Peginteron alpha and Tonfovir

Rahul's Basics (11 decks)

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