Rahul's treatments

Question 1

How do you treat asymptomatic diverticulitis

Answer 1

no treatment required

Question 2

how do you treat symptomatic diverticulitis

Answer 2

diet modification + fibre supplementation

oral antibiotics

Question 3

How do you treat uncomplicated symptomatic diverticulitis

Answer 3

Analgesia
oral antibiotics
low residue diet

2nd line:
IV antibiotics
analgesia
low residue diet

get a colonscopy 2-6 weeks later

Question 4

How do you treat complicated symptomatic diverticulitis with rectal bleeding?

Answer 4

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

Question 5

What is the step up management of pain?

Answer 5

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

Question 6

How do you manage low risk ectopic pregnancy?

Answer 6

Expectant management

Question 7

How do you manage moderate risk ectopic pregnancy?

Answer 7

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

Question 8

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

Answer 8

Surgery

Question 9

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

Answer 9

Fluid resuscitation

Surgery

Question 10

How do you manage acute renal colic non-pregnant?

Answer 10

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

Question 11

How do you manage confirmed kidney stone?

Answer 11

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

Question 12

How do you manage confirmed kidney stone with obstruction

Answer 12

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

Question 13

What is the management of pyelonephritis?

Answer 13

Antibiotics - Ciprofloxacin, Ofloxacin

Question 14

How do you manage urinary retention?

Answer 14

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

Question 15

How does the procedure for a TWOC work?

Answer 15

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

Question 16

What is the management for CENTRAL Diabetes Insipidus

Answer 16

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

Question 17

What is the management for NEPHROGENIC Diabetes Insipidus?

Answer 17

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

Question 18

How do you manage suspected MI?

Answer 18

Aspirin
Oxygen
Morphine
GTN

Question 19

How do you manage haemodynamically unstable MI?

Answer 19

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

Question 20

How do you manage haemodynamically stable MI?

Answer 20

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

Question 21

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

Answer 21

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

Question 22

What is the management of alcoholic hepatitis?

Answer 22

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

Question 23

What is the management of a patient with liver cirrhosis?

Answer 23

Treat the underlying cause

Consider a liver transplant

Question 24

How do you manage cholelithiasis?

Answer 24

Cholecystectomy

Question 25

How do you manage choledocholithiasis?

Answer 25

ERCP Endoscope retrograde choleopancreatography

Question 26

Adrenal insufficiency?

Answer 26

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)

Question 27

Addisonian crisis?

Answer 27

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

Question 28

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

Answer 28

``` 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

Question 29

How do you manage ectopic ACTH secreting tumour?

Answer 29

Surgical resection/ablation of tumour

Question 30

How do you manage adrenal disease-causing Cushing Syndrome?

Answer 30

Resection of adrenal glands | Corticosteroid replacement if needed

Question 31

How do you manage hyperkalaemia?

Answer 31

10 ml 10% calcium gluconate - stabilise myocardium + prevent arrhythmias 100 ml 20% dextrose and 10 units of insulin Nebulised salbutamol Treat underlying cause

Question 32

How do you manage hypokalaemia?

Answer 32

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

Question 33

What is the treatment for Hypercalcaemia?

Answer 33

Fluids IV bisphosphonates Haemodialysis ``` ?Calcitonin ?Denosumab ?Cinacalcet ?Steroids Surgery ```

Question 34

What is the treatment for Hypocalcaemia?

Answer 34

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

Question 35

What is the treatment of Hyperparathyroidism?

Answer 35

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)

Question 36

What is the treatment for alcohol withdrawal syndrome?

Answer 36

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)

Question 37

How would you manage a patient who is in anaphylaxis?

Answer 37

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

Question 38

How would you manage infectious mononucleosis?

Answer 38

Paracetamol or Ibuprofen Hydration Antipyretics NO ASPIRIN TO CHILDREN If upper airways obstruction/haemolytic anaemia - Corticosteroids Thrombocytopenia- Corticosteroids or IV immunoglobulin

Question 39

How do you manage chicken pox?

Answer 39

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

Question 40

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

Answer 40

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

Question 41

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

Answer 41

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

Question 42

How do you manage a cold?

Answer 42

``` Reassure the patient Hydration Analgesia Antipyretics Decongestants Antihistamine Antitussive ``` Can give paracetamol, ibuprofen oxymetazozline nasal ipratropium nasal

Question 43

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

Answer 43

Incision and drainage

Question 44

How do you manage a severe abscess

Answer 44

Antibiotics | Incision and drainage

Question 45

How do you manage infective endocarditis?

Answer 45

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

Question 46

How do you manage Hepatitis B?

Answer 46

Symptomatic treatment for acute presentation | Peginteron alpha and Tonfovir