DAY 4

Question 0

What can give a cholestasis picture with LFTs?

Answer 0

Drugs - Tazocin

Question 1

What can cause elevated AST and ALT?

Answer 1

ABCDEFGI

Autoimmune hepatitis
Hepatitis b
Hepatitis c
Drugs - paracetamol 
Ethanol 
Fatty liver disease (NASH)  
Growth (tumours) 
Haemodynamically disorders - HF 
Iron (hereditary haemachromatosis, Wilson's, budd-chiari)

Question 2

Raised AST/ALT 2:1 think? Where does ALP come from?

Answer 2

Alcoholic (toASTed/wASTed)

Bone, placenta and gut

Question 3

Causes of a cholestatic picture?

Answer 3

Primary biliary cirrhosis
Primary sclerosing cholangitis
Acute cholecystitis
Choledocholilethiasis
Cholangitis

Question 4

Acute Rx of COPD exacerbation?

Answer 4

Nebulized bronchodilators (Salbutamol, ipratropium)
Order CXR and ABG
O2 SATS 88-92%
Steroids - IV hydrocortisone and oral prednisolone
ABx - amoxicillin, azithromycin

Question 5

Features of hypercapnia?

Answer 5

Early - Flushed skin, full pulse, TACHYPNOEA, co2 retention hand flap

Severe - disorientation, panic, hyperventilation, unconsciousness and convulsions.

Question 6

Chronic Rx of COPD?

Answer 6

General - stop smoking, encourage exercise, influenza and pneumococcal vaccination. Short acting muscarinic (ipratropium) or beta agonist

Mild/Moderate - tiotropium (long acting muscarinic) or beta agonist

Severe - symbicort (budenoside + formoterol) or tiotropium