Management

Question 1

Pulmonary embolus

Haemodynamically unstable

Answer 1

1st line: analgesics, fluids, oxygen (>94%)
Thrombolysis (alteplase)
Embolectomy

Question 2

Pulmonary embolus

Haemodynamically stable

Answer 2

1st line: analgesics, fluids, oxygen (>94%)
LMWH/fondaparinux for 5 days/INR>2
Start warfarin at the same time

Question 3

40yr Pt

Primary pneumothorax <2cm

Answer 3

O2

Consider discharge

Question 4

40yr Pt

Primary pneumothorax >2cm

Answer 4

Aspirate

If unsuccessful, insert an intercostal drain

Question 5

> 50yr Pt OR

Secondary pneumothorax <1cm

Answer 5

High flow O2

Question 6

> 50yr Pt OR

Secondary pneumothorax 1-2cm

Answer 6

Aspirate
If <1cm, high flow O2
If still >1cm, intercostal drain

Question 7

> 50yr Pt OR

Secondary pneumothorax >2cm

Answer 7

Intercostal drain

Question 8

Tension pneumothorax

Answer 8

Needle decompression
-2nd intercostal mid-clavicular
O2

Question 9

Low severity pneumonia

Answer 9

Oral amoxicillin
Oxygen
Analgesics
Fluids

Question 10

Moderate severity pneumonia

Answer 10

Oral/IV amoxicillin + macrolide (eg. clarithromycin)
Oxygen
Analgesics
Fluids

Question 11

High severity pneumonia

Answer 11

IV co-amoxiclav + macrolide (eg. clarithromycin)
Oxygen
Analgesics
Fluids

Question 12

Legionella pneumophila pneumonia

Answer 12

IV macrolide or fluoroquinolone

Clarithromycin or ciprofloxacin

Question 13

Pneumocystis jirovecii pneumonia (PCP)

Answer 13

High dose co-trimoxazole

Question 14

Pseudomonas aeruginosa pneumonia

Answer 14

Piptazobactam

Piperacillin + tazobactam

Question 15

Mycoplasma pneumoniae pneumonia

Answer 15

Erythromycin/clarithromycin

Question 16

Methicillin sensitive Staphylococcus aureus pneumonia

Answer 16

Flucloxacillin

Question 17

Methicillin resistant Staphylococcus aureus pneumonia

Answer 17

Vancomycin

Question 18

H pylori-induced ulcer

Answer 18

PPI
Clarithromycin
Amoxicillin OR metronidazole

Question 19

H pylori negative ulcer

Answer 19

PPI or H2 antagonist (ranitidine)

Question 20

Haemorrhagic peptic ulcer

Answer 20

Visualise bleed (endoscopy)
Adrenaline
IV PPI
+/- transfusion

Question 21

Perforated peptic ulcer

Answer 21

NBM
IV ABx
Surgery

Question 22

Hiatus hernia

Answer 22

Risk factor modification
PPI
Nissen fundoplication

Question 23

Oseophageal varices

Answer 23

ABCDE
Fluid resus
Terlipressin- reduce portal hypertension
Endoscopy- band ligation is first line

Question 24

Cholelithiasis

Answer 24

Cholecystectomy

Question 25

Choledocholithiasis

Answer 25

ERCP

Question 26

Appendicitis

Answer 26

Appendectomy | Metronidazole and cefuroxime prophylactic ABx

Question 27

Septic arthritis

Answer 27

IV ABx after aspiration Analgesia Consider joint washout under GA

Question 28

Acute gout

Answer 28

NSAIDs (naproxen, ibuprofen, diclofenac) | Colchicine

Question 29

Chronic gout

Answer 29

Conservative management | Allopurinol

Question 30

Hypercalcaemia

Answer 30

Fluids IV bisphosphonates Haemodialysis Treat underlying cause

Question 31

Hypocalcaemia

Answer 31

IV calcium gluconate 10% Calcium chloride Vit D/Ca supplements Treat underlying cause

Question 32

Osteomalacia

Answer 32

``` Restore Vit D: -ergocalciferol -cholecalciferol -Ca supplements If in renal failure: -alfacalciferol ```

Question 33

Testicular torsion

Answer 33

Exploratory surgery

Question 34

UTI | Pt is well

Answer 34

Oral trimethoprim/nitrofurantoin

Question 35

UTI | Pt is unwell

Answer 35

IV gentamycin/ceftriaxone

Question 36

SIADH

Answer 36

Treat the underlying cause Fluid restrict to 0.5-1L If ineffective, give demeclocycline/tolvaptan

Question 37

Hyperprolactinaemia

Answer 37

``` DA agonist (bromocriptine/cabergoline) Surgery ```

Question 38

Adrenal insufficiency

Answer 38

Gluocorticoid + mineralocorticoid | Eg. hydrocortisone + fludrocortisone

Question 39

Addisonian crisis

Answer 39

50-100mg IV hydrocortisone sodium succinate every 6-8 hours | 1L saline followed by 2-4L over 24 hrs

Question 40

Phaeo hypertensive crisis

Answer 40

5-20mg phentolamine IV single dose

Question 41

Pernicious anaemia

Answer 41

IM hydroxycobalamin or oral cyanocobalamin

Question 42

Diabetic ketoacidosis

Answer 42

IV fluids IV Insulin (if K+ is normal) Potassium chloride/phosphate (unless K+ >5.3mmol/L) Supportive care + ICU admission

Question 43

Sickle cell anaemia | Vaso-occlusive crisis

Answer 43

Analgesia Antihistamine (eg. diphenhydramine) Rehydrate ABx

Question 44

Sickle cell anaemia | SOB, fever, cough (acute chest syndrome)

Answer 44

Oxygen and incentive spirometry Analgesia Antihistamine (eg. diphenhydramine) Broad spec ABx

Question 45

Graves' disease

Answer 45

Carbimazole

Question 46

Graves' disease in pregnant Pt

Answer 46

Propylthiouracil

Question 47

Anaphylaxis

Answer 47

Cardiorespiratory assessment -put in Trendelenberg position and secure airway IM adrenaline 1:1000 solution 0.3-0.5 mg 1-2L IV saline @ 5-10 mL/kg in 5 minutes Hypotensive- IV adrenaline + glucagon Resp symptoms- inhaled salbutamol Hives/rhinorrhoea- diphenhydramine + ranitidine (H1+2 antagonist) Post-emergency stabilisation- corticosteroids

Question 48

Giant cell arteritis

Answer 48

Measure ESR 80mg prednisolone Send for temporal artery biopsy

Question 49

Ascites

Answer 49

``` Spironolactone +/- frusemide Limit dietary salt Fluid restrict if hyponatraemic Measure daily weight Therapeutic paracentesis w/ IV human albumin ```

Question 50

Meningitis

Answer 50

Empirical antimicrobial therapy - ceftriaxone - vancomycin

Question 51

Alcohol withdrawal

Answer 51

Chlordiazepoxide/clomethiazole - oral: mild - IV: moderate/severe

Question 52

Alcohol withdrawal seizure

Answer 52

Lorazepam

Question 53

SAH

Answer 53

Nimodipene

Question 54

SDH

Answer 54

Craniotomy/Burr hole

Question 55

EDH

Answer 55

Craniotomy/Burr hole