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Yr 6 PACES knowledge COPY RJ Challenger > PSA > Flashcards

PSA Flashcards

1
Q

Mx of STEMI

A 
ABC + resus + O2
Aspirin 300mg PO
Morphine 5mg IV + metoclop 10mg IV
GTN spray
Primary PCI or thrombolysis (+ repeat ECG)
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2
Q

Mx of NSTEMI

A 
ABC + resus + O2
Morphine 5mg IV + metoclop 10mg IV
GTN spray
Aspirin 300mg PO 
LMWH!!! 1mg/kg SC
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3
Q

Mx of acute pulmonary oedema

A 
ABC + resus + 02
Sit up
Morphine 5mg IV  metoclop 10mg IV
Furosemide 40mg IV
If failing --> Isosorbide dinitrate infusion + CPAP
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4
Q

Mx of tachycardia + shock/MI/syncope/LVF

A

synchronised DC shock 3x
Amiodarone 300mg IV over 10-20 mins

Repeat amiodarone 900mg over 24 hours

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5
Q

Mx of a regular, narrow complex tachycardia?

A

Vagal manœuvres
Adenosine 6mg IV rapid bolus!
Repeat with 12mg. Repeat with 12mg

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6
Q

Mx of regular, broad complex tachycardia

A

Amiodarone 300mg IV over 20 mins

Then, amiodarone 900mg IV over 24 hours

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7
Q

Pt on warfarin w major bleed - what do you do?

A
  • STOP warfarin
  • Vitamin K 5-10mg IV
  • Prothrombin complex
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8
Q

Pt on warfarin w INR 7

A

Omit warfarin for 2 DAYS

Then, reduce dose

if minor bleed –> also give oral vitamin K

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9
Q

Pt on warfarin w INR 9

A

Omit warfarin

Vitamin K 1-5mg oral (even if there’s no bleed)

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10
Q

If a pt is stable w acute exacerbation of COPD, how much oxygen should be given?

A

28% O2 (roughly 2L) –> check ABG 30 mins later

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11
Q

Mx of anaphylaxis

A

Adrenaline IM 500micrograms
Chlorphenamine IV 10mg
Hydrocortisone IV 200mg

If wheeze - salbutamol nebs

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12
Q

CURB 65?

A

Confusion (AMTS 8)
Urea (>7.5)
RR (>30)
BP (<90)

> 65yo

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13
Q

Pulmonary embolism: how is LMWH given?

A

Tinzaparin

175 units/kg SC OD

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14
Q

In a GI bleed, if PT or APTT is >1.5x thermal range, what must you give?

A

FFP

UNLESS the bleed is due to warfarin, in which case give prothrombin complex

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15
Q

Mx of acute GI bleed

A

O2
Fluid resus - 0.9% saline 500mL bolus
Catheter to monitor UO
Bloods: clotting, G+S, X-Match 6 units, FBC, LFTs, U+Es

Correct clotting: if prolonged PT/APTT –> FFP
Urgent OGD
Call surgeons

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16
Q

immediate medication given for suspected bacterial meningitis

A

IM benpen
IV fluids
IV dexamethasone 10mg

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17
Q

Mx of status

A

Airway - patent?
Recovery position
O2
Bloods: look for precipitating factors (infection, electrolytes, glucose, drugs)

If lasting >5 mins:
-IV LORAZepam/buccal MIDAZolam/IV DIAZepam

  • Repeat diazepam after 2 mins
  • Inform anaesthetics + ITU + consider phenytoin
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18
Q

Timelimit for thrombolysis in acute ischemic stroke

A

<4.5hours

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19
Q

Mx of DKA

A

Airway - patent
Breathing - O2? ABG? order CXR?

Circulation:

  • Bloods: FBC, U+Es, ketones, glucose, CRP
    1) SBP<90 –> 0.9% saline 500mL bolus
    2) Fluids: 0.9% saline 1L over 1 hour, then over 2 hrs, 4 hrs, 8hrs
    3) Insulin: 1 unit/1mL of saline. 0.1 units/kg/hr.
    4) Replace K if <5.5 –> 40mM of K/1L of saline

Aim for ketones to reduce by 0.5mM/L/hr

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20
Q

Diagnosis of HONK?

Mx of HONK

A

Glucose >35
Osmolality >340
No ketones

Similar to DKA but half the rate of fluid infusion (500mL over 1 hour, then 2 hours, then 4 hours etc)
+ insulin + K replacement

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21
Q

Mx of hypoglycemia

A

Eat food
IV glucose 100mL of 20%
Im glucagon 1g

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22
Q

target BP in <80yo?

>80yo?

A

<80yo: <135/85 at home (140/85 in clinic)

> 80yo: 145/85 at home (150/85 in clinic)

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23
Q

Atrial fibrillation:

in whom would u consider rhythm control?

A

New onset AF + Haemodynamically unstable –> Electrical cardioversion

Stable + onset <48 hours –> rate or rhythm control (amiodarone 5mg/kg IV)

Stable + onset >48 hours or uncertain –> rate control + anticoagulation for 3 weeks, delay rhythm control

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24
Q

Mx of new onset AF (24 hours ago):

A

Rate control or rhythm control w

Amiodarone IV 5mg/kg

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25
Q

Rate control in AF?

A

Propanolol 10mg/6hrs
or
Diltiazem 120mg/day

26
Q

Mx of stable angina

A
  • GTN spray PRN
  • Aspirin
  • Statin
  • CVS RF control
  • one anti-angina drug: beta blocker(asthma!) or CCB (oedema!)
27
Q

Mx of stable angina in a pt who cannot tolerate B-blockers or CCBs?

A

GTN spray PRN
Aspirin
Statin
CVS RF modification

Long acting nitrate( isosorbide mononitrate) or K channel activator (nicorandil)

28
Q

What test is done to check for nephropathy in DM?

A

Albumin:creatinine ratio

29
Q

eg of long-acting insulin

A

GLargine

30
Q

Indication for oral hypoglycemics in T2DM

A

HbA1c =>48mM/L (after diet + exercise)

31
Q

1st line medical mx of T2DM

A

Metformin 500mg w breakfast

32
Q

1st line medical mx of T2DM - when might you NOT use metformin?

A

If pt is low/normal weight, or if their creatinine>150

Gliclazide!

33
Q

T2DM: if pt is still HbA1c>48 and on metformin + gliclazide… what can you give?

A

Gliptin (DPP-4 inhibitor)

34
Q

mediations to avoid in PD patients?

A

Haloperidol + metoclopramide

35
Q

Commonly used drug in PD

A

Co-beneldopa

or co-careldopa

36
Q

2 drugs used for absence seizure mx?

A

VPA

ethosuximide

37
Q

2 drugs used for focal seizure mx? side effects?

A

VPA - teratogenicity

Lamotrigine - rash

38
Q

Crohns disease: what drugs are used to treat a flare up?

A

Mild: oral pred

Moderate/severe: IV hydrocortisone 100mg/6hrly + supportive Mx

39
Q

Crohns disease: what drugs are used to maintain remission? cautions?

A

Azathioprine or 6 mercaptopurine

MUST check TPMT activity before starting: if low, there is risk of toxicity. consider MTX in those patients

40
Q

Maintenance treatment of Rheumatoid arthritis

A

Methotrexate + another DMARD:

sulfasalazine or hydroxychloroquine

^if poor response to 2 DMARDs –> add anti-TNF

41
Q

Mx of a flare in RA?

A

Short term steroids: IM methylpred
Short term NSAIDs: ibuprofen + PPI

Reinstate DMARDs if dose was recently reduced

42
Q

indications for 5% dextrose (and not NS) in fluid management?

A

Hypoglycaemic or hypernatremic

43
Q

Fluid replacement in pt with ascites? why?

A

Human Albumin Solution (HAS)

  • maintains oncotic pressure
44
Q

General rule for maintenance fluid in adults?

A

3L a day:

1L of 0.9% saline
2L of 5% dextrose

Add K (guided by U+Es) - approx 40mM/day

45
Q

Pain relief: for mild pain - regular vs PRN?

A

Regular: Paracetamol 1g every 6 hours
PRN: Codeine 30mg - max every 6 hours

46
Q

Pain relief for severe pain - regular vs PRN?

A

Regular: Co-codamol 30/500, 2 tablets every 6 hours
PRN: Morphine sulphate 10mg, max every 6 hours

47
Q

Anti-emetics: which are best to use?

A

Cyclizine UNLESS they have heart failure –> give metoclopramide

48
Q

Mx of painful diabetic neuropathy

A

Duloxetine

49
Q

Stimulant laxative? -ve effect?

A

Senna

Can worsen abdo cramps

50
Q

Osmotic laxative? -ve effect?

A

Phosphate enema or Lactulose

Can worsen bloating

51
Q

Bulking laxative? -ve aspect?

A

Isphagula husk - but takes days to take effect

52
Q

Stool softener laxative?

A

Docusate

53
Q

Mx of chronic diarrhoea

A 
Loperamide - 2mg, max every 3 hours
or codeine (if painful) - 30mg every 6 hours
54
Q

Pts with insomnia: what must you consider first?

Appropriate medication?

A

Are they on corticosteroids?

Consider zopiclone 7.5mg (or 3.75 if elderly!)

55
Q

Which medication which is used for neuropathic pain, can causeneutropenia?

A

Carbemazepine

56
Q

Drugs with antimuscarinic side effects:
Anti-emetic?
Neuropathic pain relief?

A

cyclizine

amitriptyline

57
Q

Which 2 drugs are defo best avoided in parkinnsons?

A

Haloperidol

Metoclopramide

58
Q

What does 1% lidocaine actually mean

A

1g of lidocaine in 100mL

59
Q

General threshold for RBC transfusion

A

Hb<70g/L

OR

<80g/L in ACS

60
Q

When NOT to give platelets prophylactically?

A

ITP
TTP
Heparin induced thrombocytopenia
Chronic BM failure

61
Q

Indications for FFP?

A

if APTT or PT are prolonged + pt is bleeding/due surgery

62
Q

Indication for cryoprecipitate

A

Low fibrinogen AND bleeding/due surgery

Yr 6 PACES knowledge COPY RJ Challenger (16 decks)

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