6/3

Question 1

What antibiotics are used as first line treatment in Lyme disease

Answer 1

1. Doxycline
2. Amoxicillin (if allergic to doxy)

Question 2

COPD and asthma pathways

Question 3

What is the most common cause of infective COPD exacerbation?

How is it managed?

Answer 3

Haemophillius influenza

Oral prednisone 30mg OD 5 days
+ antibiotics but ONLY if purulent sputum or signs of pneumonia
- amox
- doxy
- OR clarithomycin

Question 4

What must be prescribed at the same time as starting allopurinol?

Answer 4

NSAID cover - can cause a gout flare up otherwise

Question 5

Hip fracture management

Answer 5

1 + 2 - use a screw

3 + 4 - displaced, replace

1 = partial fracture, no displacement
2 = full fracture, no displacement
3 = full fracture, partial displacment
4 = full fracture, full displacement

Question 6

In what situations are each of the following hip screws used:
- Cannulated hip screw
- Dynamic hip screw
- Intramedullary nail

Answer 6

All non-displaced

1. Intra-capsular
2. Inter-trochanteric
3. Sub-trochanteric

Question 7

Signs of OA on XR

Answer 7

LOSS

Loss of joint space
Osteophytes
Subchondral cysts
Subcondral sclerosis

Question 8

What antibiotic is used for MRSA?

Answer 8

Vancomycin

Question 9

What antibiotic is used as phrophlayxis if had one episode of SBP?

Answer 9

Ciprofloxacin

Question 10

What identifies an asthma attack as near-fatal?

Answer 10

PaCO2 >6

Features that would make it life-threatening:
- Low sats
- Silent chest
- Agitation/altered GCS

Question 11

What must be met in order to safely discharge a pt post acute asthma inpatient stay?

Answer 11

• PEFR >= 75% of predicted/best (baseline)
• Been stable off nebulisers for 24hrs
• Review inhaler compliance and technique
• Written take home management plan
• Inform GP for community review within 48hrs

Question 12

What is a Venturi mask?

Answer 12

Controlled oxygen therapy
- most important with CO2 retainers

Question 13

When a COPD pt is on maximal treatment and still symptomatic they can be considered for long term oxygen therapy. What do they need for that?

Answer 13

• NON - SMOKING

Either:
2 ABGS 3 months apart that show hypoxia

OR

Hypoxia plus compliactions (1 of)
- secondary polycythaemia
- pul HTN
- nocturnal hypoxaemia
- peripheral oedema

Question 14

Reminder of CURB65 indications after calculation

Answer 14

2 = IV ABx in hospital
3 = ITU review needed
4 = ITU strongly indicated

Question 15

How is a simple pneumothorax >2cm managed?
<2cm - not suitable for intervention

Answer 15

Needle aspiration if pt wants symptom relief if not conservative carei