Section 3: Planning management

Question 1

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

Answer 1

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.

Question 2

How do you manage bacterial meningitis in hospital?

Answer 2

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

Question 3

How do you manage viral meningitis?

Answer 3

IV aciclovir 10mg/kg TDS + supportive Mx

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

Question 4

How do you manage bacterial meningitis w suspected meningococcal septicaemia?

Answer 4

IV/ IM cefotaxime 8g QDS

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

Question 5

What are the principles of managing AF?

Answer 5

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

Question 6

How do you manage upper GI bleed?

Answer 6

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

Question 7

What is the initial management for UC?

Answer 7

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

Question 8

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

Answer 8

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

Question 9

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

Answer 9

Azathioprine OR mercaptopurine +/- methotrexate

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

Question 10

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

Answer 10

Azathioprine* OR mercaptopurine +/- methotrexate

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

Question 11

What is the management for acute gout?

Answer 11

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

Question 12

What is the prophylaxis for gout?

Answer 12

Lifestyle modification, manage risk factors

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

Febuxostat 80mg OD PO

Question 13

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

Answer 13

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

Question 14

How do you manage acute pulmonary oedema?

Answer 14

Loop diuretics i.e. furosemide 80mg IV injection

Question 15

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

Answer 15

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

Question 16

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

Answer 16

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

Question 17

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

Answer 17

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

Anticoagulate for at least 3 weeks before cardioverting.

Question 18

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

Answer 18

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

Question 19

What is first line antibiotic for skin infections?

Answer 19

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

Question 20

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

Answer 20

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

Question 21

When should women planning pregnancy take folic acid?

Answer 21

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

Question 22

What is the target cholesterol effect for patient on statin?

Answer 22

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