Treatments in a Primary Setting

Question 1

How do you treat pulmonary oedema?

4

Answer 1

• Give Glyceryl trinitrate spray 2 puffs sublingually.
• Give i.v.:
  Diuretic: Furosemide 20mg to 50mg slowly
  Opioid: Diamorphine 2.5mg to 5.0mg slowly
  Anti-emetic: Metoclopramide 10mg

Question 2

There are 2 non-pharmacological ways you could treat a SVT, in this setting.

Discuss them.

Answer 2

Valsalva manoeuvre - tell the patient to blow into a syringe for 15s whilst they are lying down, face up

Carotid sinus massage (ensure that there is a defibrillator as this massage can cause another arrhythmia and ensure that there is an ECG so you can monitor the heart)

Question 3

Give 4 circumstances where you should not do a carotid sinus massage as a form of treatment for SVT

Answer 3

1. Digoxin toxicity
2. History of TIA
3. IHD (ischaemic heart disease)
4. Elderly

Question 4

2 skin SE of Corticosteroids

Answer 4

Thins the skin

Hypopigmentation

Question 5

What is the first line treatment for acute bronchitis (if you feel like the condition isn’t self-limiting)?

Answer 5

Doxycycline (200mg day 1 then 100mg day 2-5)
(Can also give Amoxicillin or a Macrolide if preferred)
(If preg then give Erythromycin)

Question 6

What is pseudogout?

Give 3 risk factors.

Answer 6

Pseudogout is a form of inflammatory arthritis and is caused by the deposition of calcium pyrophosphate crystals in the joint.

• Old age
• Hyperparathyroidism
• Hypophosphatemia

Question 7

How will a patient with Pseudogout present (2)?

Answer 7

Patients will present acute onset joint swelling, and subcutaneous deposits can also occur near the affected joint.

Question 8

Pseudogout typically affects proximal joints.

Name 2 proximal joints that are typically affected.

Answer 8

Wrist

Knee

Question 9

What is the first line treatment off pseudogout

Answer 9

NSAIDs (and treat underlying cause)