Covid 19

Question 1

when do symptoms appear after infection with COVID-19 cap

Answer 1

afetr 6 days

Question 2

early symptoms of disease cap

Answer 2

cough
malaise
anosmia
headache
myalgia

Question 3

level of severity

absence of signs of severe or critical disease

Answer 3

non severe

Question 4

level of severity

sp02 less than 90% on air
resp rate above 30
raised resp rate in children
signs of severe resp distress

Answer 4

severe

Question 5

level of severity

requires life sustaining treatment
acute respiratory distress syndrome
sepsis
septic shock

Answer 5

critical

Question 6

symptoms of severe covid pneumonia

Answer 6

severe breathlessness
rr over 30
saturation below 90

Question 7

x rays can show basal atelectasis, what does this mean

Answer 7

collapsed lungs

Question 8

what might you see in a ct in severe covid

Answer 8

ground glass infiltrates

Question 9

what biomarkers would be raised

Answer 9

crp
fibrinogen
d dimers
ldh
ferritin

Question 10

true or false, covid is not prothrombotic and does not increase clot risk

Answer 10

false

Question 11

what causes cytokine storm

Answer 11

body inflammatory response

Question 12

asiatics have greater expression of x which is associated with poorer outcomes

Answer 12

tyk2

Question 13

asiatics have lower x which is associated with poorer outcomes

Answer 13

IFNAR2

Question 14

elevated x is associated with increased mortality and thrombosis

Answer 14

d dimer

Question 15

what does inf reduce

Answer 15

inflammation

Question 16

what prevents the use of inf

Answer 16

cost

Question 17

how can proning help patients with covid

Answer 17

less shunting in lungs
alveoli expand

Question 18

name a mab that clocks viral entry into health cells and clears infected cells from sars cov 2

Answer 18

sotrovimab

Question 19

sotrovimab is reserved for use in which px

Answer 19

high risk

Question 20

vit d deficiency means more likely for hypocalcaemia, what benefit can it have for covid

Answer 20

correct low calcium at worst and help immune system at best

Question 21

steroids may benefit patients, what 2 ppis may be given alongside for gastro protection to stop gi bleeds

Answer 21

lansoprazole or omeprazole

Question 22

oxygen can be given at 4-6ml/min in order to gets sats of

Answer 22

92-96%

Question 23

continuous positive airway pressure - cpap machines help control pressure and amount of o2 given to aid breathing, why do staff require high levels of ppe with suitable masks

Answer 23

aerosols putting healthcare workers at risk

Question 24

imv requires pt to be sedated and a breathing tube is put into where

Answer 24

windpipe
(intubation)

Question 25

why do some patients on ventilation benefit from proning

Answer 25

opens up more of lung and allows for better gas exchange between air and bloodstream

Question 26

ecmo allows lungs to be rested and acts as artifical lung giving them a better chance to heal, what is a setback

Answer 26

small number of specialist centres in the uk

Question 27

different ways to deliver oxygen in order of escalation

Answer 27

nasal cannula non rebreather mask cpap imv ecmo

Question 28

haematological increases in lab results

Answer 28

d dimer fibrinogen crp ldh ferritin

Question 29

haematological DEcreases in lab results

Answer 29

lymphocytes (hypo)calcaemia

Question 30

name some groups of high risk px

Answer 30

organ transplant chemo/ antibody tx for cancer and immunotherapy intense radiotherapy leukemia, lymphoma, myeloma severe lung condition dialysis immunosuppressed/ high steroid dose

Question 31

what percentage of anti retrovirals does a patient have to take to treat hiv effectively

Answer 31

90%

Question 32

what dose of enoxaprin is needed for pe

Answer 32

1.5mg/kg od or 1mg/kg bd

Question 33

what does apixaban inhibit to work

Answer 33

factor xa

Question 34

why is apixaban a better choice than enoxaparin on discharge

Answer 34

equally effective better compliance less painful no routine monitoring

Question 35

how would you manage a patient as on 80% o2 cpap and poor sats below 90%

Answer 35

increase to 100% o2 cpap and dexamethasone iv 6mg od and stat dose of toclizumab 800mg iv od

Question 36

if a patient had high lactate what changes would you make to their metformin therapy and why

Answer 36

stop because it causes lactic acidosis (rare)

Question 37

why would bendrofluazide not be appropriate for a bp of 180/110

Answer 37

not strong enough as patient at risk of heart attack or stroke

Question 38

what drug and dose if px has bp 180/110 and hr 110 bpm

Answer 38

amlodipine 5mg ng as can not crush MR nifedipine

Question 39

what drug would you use to stop breast milk to reduce engorgement and risk of mastitis

Answer 39

cabergoline 1mg stat

Question 40

name a reversal agent for paralysis

Answer 40

neostigmine

Question 41

suitable drug to paralyse patients quickly at 50mg stat dose then 0.6mg/kg/hr and still metabolises in low kidney or liver function

Answer 41

atracurium

Question 42

vit d levels below x is deficient

Answer 42

25

Question 43

alfacalcidol is only used in x patient

Answer 43

renal failure

Question 44

how does baricitinib work in covid 19

Answer 44

modulates janus kinase enzyme to reduce cytokine storm

Question 45

other therapeutics for COVID-19

Answer 45

remdesivir, tocilizumab, baracitinib

Question 46

how long does it take the pfizer vaccine to be effective

Answer 46

21 days

Question 47

first line NRV novel antiviral for high risk px

Answer 47

paxlovid molnupiravir - outpx