Section 3: Planning management Flashcards

1
Q

How do you manage status epilepticus (seizure >5min)?

A

Give 1 dose of lorazepam 4mg IV, then repeat after 10 min, then give phenytoin 20mg/ kg IV (max 2g) [loading dose] - contact ITU

Alternatives: diazepam PR or buccal midazolam.

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2
Q

How do you manage bacterial meningitis in hospital?

A

IV ceftriaxone 2-4g OD in hospital + supportive Mx

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3
Q

How do you manage viral meningitis?

A

IV aciclovir 10mg/kg TDS + supportive Mx

Note: May be less unwell than bacterial meningitis, must be confirmed by CSF findings

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4
Q

How do you manage bacterial meningitis w suspected meningococcal septicaemia?

A

IV/ IM cefotaxime 8g QDS

In the community/ hospital transfer not possible - IM benzylpenicillin 1.2g STAT or IM cefotaxime 1g STAT (if PA)

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5
Q

What are the principles of managing AF?

A

If haemodynamically unstable - DC cardioversion

In younger patients/ not responsive to rate control - pharmacological cardioversion

In older patients/ not responsive to rhythm control - rate control

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6
Q

How do you manage upper GI bleed?

A

Fluid resuscitation with IV NaCl/ Hartmann’s

If variceal bleed suspected, give terlipressin and prophylactic antibiotics (high risk of SBP)

Urgent OGD to stop bleeding and locate source

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7
Q

What is the initial management for UC?

A

Prednisolone 20-40mg OD until remission occurs followed by reducing doses + mesalazine (PO/ TOP)

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8
Q

What is the management for Crohn’s to induce remission?

A

Prednisolone 20-40mg OD until remission occurs followed by reducing doses +/- azathioprine/ methotrexate/ biologics

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9
Q

What is the management for Crohn’s to maintain remission?

A

Azathioprine OR mercaptopurine +/- methotrexate

Note: use same drug used to induce remission, but do not use corticosteroids long term

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10
Q

What is the management for Crohn’s to maintain remission?

A

Azathioprine* OR mercaptopurine +/- methotrexate

*Check contraindications in BNF when prescribing e.g. low or absent TPMT activity

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11
Q

What is the management for acute gout?

A

1st line - NSAIDS e.g naproxen, diclofenac
2nd line - colchicine 500mcg BD-QDS (when NSAIDs CI e.g. heart failure, anti-coagulants)
3rd line - corticosteroids

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12
Q

What is the prophylaxis for gout?

A

Lifestyle modification, manage risk factors

Allopurinol 100mg OD PO (titrate accordingly, after food)

Febuxostat 80mg OD PO

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13
Q

How do you manage anaphylaxis, after adrenaline 0.5mg IM has been administered without symptom improvement?

A

Give another dose of adrenaline 0.5mg IM after 5 min, and every 5 min if not improving

Note: also give chlorphenamine 10mg IV and hydrocortisone 200mg IV

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14
Q

How do you manage acute pulmonary oedema?

A

Loop diuretics i.e. furosemide 80mg IV injection

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15
Q

A 5yo boy comes into the ED with a sore throat, strawberry tongue, fever >38C, macular rash. What is the treatment?

A

Likely scarlet fever/ group A strep.
If oral fluids tolerated, PO phenoxymethylpenicillin for 10 days.
If not, IV amoxicillin is an alternative.

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16
Q

How do you treat tachycardia (with pulse) with adverse features?

A

Synchronised DC shock x3, then amiodarone 300mg IV over 10-20 min then shock again, then amiodarone 900mg over 24h

17
Q

How do you treat AF that started more than 48h ago?

A

Electrical/ DC cardioversion preferred over pharmacological e.g. with flecainide/ amiodarone.

Anticoagulate for at least 3 weeks before cardioverting.

18
Q

In an asthmatic patient who is currently on salbutamol, what would indicate need to escalate Tx?

A

Nocturnal cough or use of salbutamol > 2x weekly (which can precipitate a tremor). Next step is to add an ICS e.g. beclomethasone 200mcg.

19
Q

What is first line antibiotic for skin infections?

A

Flucloxacillin 500mg 6 hourly for 7 days, PO. Consider IV flucloxacillin 1g in severe cellulitis if patient unwell.

20
Q

What would you prescribe for women with a FHx of spina bifida?

A

Folic acid 5mg daily until week 12 of pregnancy - for all women at high risk of having child with neural tube defects

21
Q

When should women planning pregnancy take folic acid?

A

Before conception and until week 12 of pregnancy. All should take a lower dose of 400 micrograms daily.

22
Q

What is the target cholesterol effect for patient on statin?

A

Non-HDL/ LDL cholesterol should be reduced at least 40%.I Increase dose if necessary.