general medicine

Question 1

treatment of hypercalcaemia?

Answer 1

IV fluid therapy first line
can also use calcitonin - quicker effect than bisphosphonates
steroids in sarcoidosis

Question 2

Daily requirements in fluid therapy

Answer 2

1.5ml/kg/hr of water
1mmol/day of sodium and potassium

Question 3

Types of fluids

Answer 3

Crystalloid: similar to ECF include normal saline, hartmans, hypotonic Saline

Colloids: solutions of larger molecules that exert oncotic pressure

Question 4

anaesthetic induction agents

Answer 4

propofol, sodium thiopentone, ketamine, etomidate

Question 5

What metabolic abnormality does paracetamol overdose lead to?

Answer 5

Metabolic acidosis
ABG pH is the most important prognostic factor

Question 6

Treatment for tricyclic overdose

Answer 6

IV bicarbonate

Question 7

Measles presentation

Answer 7

Fever, maculopapular rash and white spots in the mouth
Otitis media is an important complication

Question 8

Treatment of lithium toxicity

Answer 8

Fluid resuscitation with normal saline
Haemodialysis in severe toxicity

Question 9

causes of hepatomegaly

Answer 9

cirrhosis
malignancy
right heart failure
viral hepaitis
glandular fever
malaria

Question 10

what is the glucose requirement in fluid therapy

Answer 10

50-100g / day regardless of patients weight

Question 11

How does hypomagnesemia present
How is it treated

Answer 11

Parasthesia is the main presenting symptom
Can also get seizures and arrhythmias

If less than 0.4 mmol/l give IV magnesium sulphate
If >0.4 mmol/l then oral magnesium salts

Question 12

What is the normal range of anion gap

Answer 12

10-18 mmol/L
Calculated by [Na+ + K+] - [HCO3- + Cl-]

Question 13

What electrolyte abnormality is associated with acute pancreatitis

Answer 13

Hypocalcaemia

Hypokalaemia may also be seen due to vomiting

Question 14

Management of hypocalcaemia

Answer 14

Severe hypocalcaemia- IV replacement preferably IV calcium gluconate 10ml 10% solution over 10 minutes
ECG monitoring
Identify underlying cause using PTH levels

Question 15

What is an anaphylactoid reaction? (Antibodies)

Answer 15

A reaction that produces the same clinical picture as anaphylaxis but is NOT IgE mediated

Question 16

management of hyperkalaemia?

Answer 16

IV calcium gluconate for cardiac protection

Short-term shift in potassium from ECF to ICF using combined insulin/dextrose infusion and nebulised salbutamol

Removal of potassium from the body
- calcium resonium (orally or enema)
enemas are more effective than oral as
- loop diuretics
- dialysis
haemofiltration/haemodialysis should be considered for patients with AKI with persistent hyperkalaemia

stop exacerbating drugs such as ACEi

Question 17

legionella

Answer 17

lymphopenia, hyponatraemia & deranged LFTs

diagnose with urinary antigen testing

treat with erythromycin/clarithromycin

Question 18

what is an ORBIT score

what does it include

Answer 18

recommended scoring tool to assess bleeding risk in patients with atrial fibrillation who are being considered for anticoagulation. a score of 4-7 is high risk

Haemoglobin <130 g/L for males and < 120 g/L for females, or haemtocrit < 40% for males and < 36% for females (2 points)

Age > 74 years (1 point)
Bleeding history (GI bleeding, intracranial bleeding or haemorrhagic stroke) (2 points)

Renal impairment (GFR < 60 mL/min/1.73m2) (1 point)

Treatment with antiplatelet agents (1 point)