Management of Common Conditions Flashcards

Question

Management of PUD

Answer 1

- General measures: - Avoid NSAIDs - Restrict alcohol, smoking, caffeine - Test for H. pylori infection (e.g. urea breath test) - Positive: H. pylori eradication therapy - 2 weeks course of azithromycin + amoxicillin + PPI - Confirm that H. pylori has been eradicated 4–6 weeks after completion of the treatment regimen - Negative: Trial of PPIs for 4-8 weeks and re-evaluate - Failure: elective surgery

Answer 2

- Lifestyle: - Diet: small portions, avoid eating before sleeping - Weight loss - Avoid caffeine, smoking, alcohol - Pharmacological: - PPI regimen for 8 weeks - Alternative: H2 antagonists - Review clinical response after 8 weeks - Surgical: when symptoms are refractory to medical therapy or presence of complications - Fundoplication: wrapping of the top part of the stomach around the lower part of the esophagus to prevent reflux

Answer 3

- Low-surgical risk: - Pneumatic dilation - LES myotomy - High surgical risk: - Botulinum toxin injection in the LES

Answer 4

- Initial management: - IV fluids: crystalloids (e.g. CSL) - Monitor vitals, O2 sat, urine output - Obtain lab studies (FBE, UEC) every 6-12h to assess adequacy of fluid resuscitation and tissue perfusion - Replete electrolytes as needed - Supportive therapy: - Analgesia: NSAIDs or opioids - Antiemetic: IV ondansetron - Antibiotic: only in patients with evidence of infected necrosis - Feeding: - Fasting is no longer recommended - Early oral feeding or via nasogastric tube - Management: - Biliary pancreatitis: - Therapeutic ERCP and stone removal - Cholecystectomy - Alcohol-induced: - Check Mg and PO4- levels and replete as needed - Vitamin supplementation (B1 and B6)

Answer 5

- Investigate for nutrient deficiencies: iron, vitamin B12, folate, vit D - Supplementation as needed - Screen for osteopenia by BMD scan - **Gluten-free diet**

Answer 6

- First-line treatment: 5-ASA (mesalamine) - Alternative: oral corticosteroids - For severe cases: consider adding biologics (e.g. anti-TNF therapy) - Supportive therapy: - Analgesics: paracetamol, sedatives - avoid opioids and NSAIDs - Identify and treat any micronutrient deficiency

Answer 7

- Induction phase: to manage acute flares - Corticosteroids, biologics - Maintenance phase: - Biologics (e.g. anti-TNF - adalimumab - Immunomodulators (e.g. azathioprine, methotrexate) - Supportive therapy: - Pain management - Antidiarrheal therapy: loperamide - Identify and treat nutritional deficiency

Answer 8

- Uncomplicated (w/o perforation, peritonitis, sepsis, etc) - Empirical antibiotic: oral Augmentin for 5 days - Supportive care: - Bowel rest: clear liquid diet until symptoms improve - Analgesics and antiemetics - Complicated - Empirical antibiotics: IV gentamicin + amoxicillin + metronidazole - Duration: no surgery (7-10 days); had surgery (5 days) - Surgical intervention: - Drainage of abscess - Potential colectomy or Hartmann - Supportive care: - NPO - IV fluids - Analgesics and antiemetics

Answer 9

- Initial support: - NPO - Analgesics and anti-emetics - Surgical management: Cholecystectomy - If evidence of choledocholithiasis, removal of CBD stone (via ERCP)

Answer 10

- Initial management: - NPO - Analgesics - Antiemetics - Empirical antibiotics: IV gentamicin + amoxicillin - Alternative: IV Augmentin or ceftriaxone - Stop after cholecystectomy - Surgical management: laparoscopic cholecystectomy

Answer 11

- Stabilize patient as needed - Initial management: - NPO - Analgesics - Antiemetics - Empirical antibiotics: IV gentamicin + amoxicillin - Alternative: IV ceftriaxone - Definitive management: - Biliary drainage (ERCP-guided) - Treatment of underlying cause: - Choledocholithiasis: ERCP-guided stone extraction and cholecystectomy - Biliary stricture: ERCP and CBD stenting

Answer 12

- Initial management: - NPO - IV fluids, analgesia, antiemetics - Electrolyte repletion as needed - Screen for peritoneal signs or sepsis - Empirical antibiotic: IV gentamicin + metronidazole + amoxicillin - For uncomplicated appendicitis, stop after appendicectomy. - Surgical management: emergency appendicectomy

Answer 13

- Usually self-limiting - Pharmacological therapy: - NSAIDs: aspirin - Consider colchicine in combination with NSAIDs - Supportive therapy: - Antibiotics for bacterial causes - Immunosuppressants in autoimmune disease - Dialysis (in case of uremia and CKD)

Answer 14

- Stabilisation (ABCDE approach) - Immediate hemodynamic support (IV saline and/or vasopressors) - Respiratory support (consider early intubation) - Management of encephalopathy and increased ICP - refer early for liver transplant - consider lactulose + rifaximin - neuroprotective measures - Supportive therapy - Electrolyte repletion and optimize nutrition - Hemostasis: correct coagulopathy and consider stress ulcer prophylaxis (e.g. PPIs)

Answer 15

- Primary prevention: non-selective beta blocker (e.g. propranolol) and/or band ligation - Management - Terlipressin or octeotride - Emergency endoscopy: - Band ligation - Antibiotic prophylaxis: ceftriaxone - Secondary prevention: - Long-term beta-blocker therapy - Variceal band ligation - Regular endoscopy - Consider TIPS placement

Answer 16

- Medical management - Lifestyle modification - Long term: - statin therapy - antiplatelet therapy - Surgical management - Symptomatic: carotid revascularization if stenosis >70% - within 14 days of symptoms onset - Modalities: - Carotid endarterectomy - Carotid artery stenting

Answer 17

- Conservative management (observe for 48-72h) - Rest, warm compresses, drinking fluids - Avoiding irritants (e.g. smoke) - Pain relief: paracetamol - Antibiotics: recommended to relieve symptoms if have not improved - Amoxicillin: first line - Cefuroxime: alternative for patients with penicillin allergy

Answer 18

- Conservative management: - Avoiding allergens - Nasal saline irrigation - Medical/pharmacological management: - Antihistamines (e.g. loratadine) - Intranasal corticosteroids (e.g. fluticasone) - Immunotherapy (desensitization)

Answer 19

- Lifestyle management - Rest and adequate nutrition - Avoidance of alcohol and other hepatotoxic substances - Supportive therapy for acute viral hepatitis (e.g. antiemetics, IV fluids, and electrolyte replacement) - Medical management - Antiviral therapy for chronic viral hepatitis B and C infections - Vaccination against hepatitis A and B for prevention of infection

Answer 20

- Symptomatic treatment - Nasal irrigation with saline solution to help clear the sinuses - Steam inhalation or use of a humidifier to moisten nasal passages - Avoiding irritants (e.g. smoke) - Medical management - Antibiotics if bacterial infection is suspected or confirmed (e.g. amoxicillin, cefuroxime) - Consider: - Intranasal corticosteroids to reduce inflammation in the sinuses (e.g. fluticasone) - Decongestants to reduce nasal congestion (e.g. pseudoephedrine) - Pain relief: paracetamol or ibuprofen

Answer 21

- Symptomatic management: - Saltwater gargles - Use of throat lozenges or sprays for symptomatic relief - Pain relief: paracetamol or ibuprofen - Medical management: - Antibiotics if bacterial infection is confirmed (e.g. penicillin V, amoxicillin) - Common etiology: GAS - Tonsillectomy may be considered for recurrent or severe cases

Answer 22

- Non-medical management: - Positional maneuvers such as the Epley maneuver to alleviate symptoms of benign paroxysmal positional vertigo (BPPV) - Avoiding sudden head movements and potential triggers such as alcohol or caffeine - Vestibular rehabilitation therapy, which involves exercises to improve balance and reduce symptoms of dizziness and vertigo - Medical management: - Vestibular suppressants (e.g. meclizine) or antiemetics to manage symptoms of vertigo and nausea - Steroids to reduce inflammation (e.g. prednisone) may be used in some cases (e.g. labyrinthitis)

Answer 23

- Setting: if uncomplicated, management can be done in an outpatient setting - Complicating factors: risk factors for infection, treatment failure, serious outcomes - Supportive measures: - Increase fluid intake - Regular voiding - Proper hygiene practice - Medical management - Pain relief: paracetamol - Antibiotics: trimethoprim for 3 days (uncomplicated) or 7-14 days (complicated) - Refer to urology if complicated

Answer 24

- If hemodynamically unstable, perform fluid resuscitation, admit to ICU and initiate sepsis workup - General management - IV fluids - Analgesia, antiemetics - Empirical antibiotics after collecting urine samples for MCS - Uncomplicated: oral Augmentin for 2 weeks or ciprofloxacin for 7 days - Complicated: IV gentamicin + amoxicillin up to 2 weeks - Antibiotic choice adjusted after MCS results - Assess for complications: - Septic screen - Blood culture - Percutaneous drainage for abscess

Answer 25

- Non-medical management: - Psychotherapy, such as cognitive behavioral therapy (CBT), to address underlying emotional issues that may contribute to the eating disorder - Nutritional counseling to promote healthy eating habits and meal planning - Support groups - Medical management: - SSRIs may be prescribed to help address underlying mood disorders - In some cases, hospitalization may be necessary for close monitoring of weight, nutritional status, and electrolyte balance, and to provide intensive treatment for the eating disorder

Answer 26

- Inpatient treatment if low BMI, failed outpatient treatment, medically or psychologically unstable - Non-medical management: - Psychotherapy, such as cognitive behavioral therapy (CBT), to address underlying emotional issues that may contribute to the eating disorder - Nutritional counseling to promote healthy eating habits and meal planning - Support groups - Medical management: - SSRIs may be prescribed to help address underlying mood disorders - In some cases, hospitalization may be necessary for close monitoring of refeeding syndrome - Monitoring and correction of electrolyte imbalances - Nutritional and micronutrient (e.g. thiamine) repletion

Answer 27

- Depends on underlying cause: - Prerenal: correct adverse hemodynamic factors and replete fluid as needed - Postrenal: relieve urinary obstruction (temporarily using catheters) - Intrinsic: consider IV fluids and address specific causes - Supportive measures: - Avoid nephrotoxic medications - Consider medication dose adjustment based on renal function - Manage volume status and blood pressure to optimize kidney perfusion - Others: nutritional support, VTE prophylaxis - Renal replacement therapy (e.g. hemodialysis, peritoneal dialysis) - Consider if complications refractory to medical management or uremic symptoms

Answer 28

- Control blood pressure (<130/80 mmHg) - Use ACE inhibitors or ARBs in patients with proteinuria - Manage blood glucose levels in patients with diabetes - Consider using or adding SGLT-2 or GLP-1 agonist - Address underlying causes of CKD (e.g. obstructive uropathy, glomerulonephritis, polycystic kidney disease) - Prevent and manage complications of CKD - Nutritional management: ensure adequate fluid intake, consider salt and protein restriction - Referral for specialist evaluation - Monitor electrolytes, bone mineral metabolism, anemia, and cardiovascular risk factors - Renal replacement therapy (RRT) planning - Discuss options for RRT, including dialysis and kidney transplantation

Answer 29

- If pulseless, start CPR and defibrillate - If unstable with pulse, perform synchronized cardioversion - Stable patients: - If undifferentiated, start by performing vagal maneuvers (e.g. valsalva) - Reassess rhythm - Regular SVT: administer adenosine first-line (second-line: verapamil) - Irregular SVT: see management for AF - rhythm vs rate control - Consult cardiology for definitive management

Answer 30

- Attach defibrillator pads to patient - Assess 12-lead ECG to check for morphology - Monomorphic VT: - Stable: pharmacological cardioversion (e.g. amiodarone, procainamide) - Unstable: synchronized electrical cardioversion - Polymorphic (most commonly Torsades de pointes): - Stable: IV magnesium - Unstable: Defib + PCR

Answer 31

- Pharmacotherapy for CAD - Antianginal: beta-blockers, CCBs, nitrates - Secondary prevention: - antiplatelets - statins - ACEi/ARBs: for hypertension - Consider revascularisation if high-risk lesions: CABG, PCI

Answer 32

- Preventative: - Patient education - Lifestyle modification: weight reduction, diet and nutrition, exercise, smoking cessation - Evaluation for other comorbidities: - Autoimmune conditions (celiac, autoimmune thyroid) - Psychiatric disorders (depression, anxiety) - Routine screening: macro and microvascular complications - CVD risk assessment and prevention: - Hypertension - Lipid profile - HbA1C and fasting glucose - Other tests: - Diabetic neuropathy: monofilament test - Diabetic nephropathy: ACR (albumin-creatinine ratio), eGFR, UEC - Diabetic foot: pedal pulses - Diabetic retinopathy: visual acuity tests - Refer to specialist for further examination - Insulin therapy - Glycemic monitoring: assess hypoglycemia or impact of diet - Mode of therapy: - Basal-bolus insulin regimen - Insulin pump (commonly used)

Answer 33

- Preventative: - Patient education - Lifestyle modification: weight reduction, diet and nutrition, exercise, smoking cessation - Evaluation for other comorbidities: - OSA, fatty liver disease - Psychiatric disorders (depression, anxiety) - Routine screening: macro and microvascular complications - CVD risk assessment and prevention: - Hypertension - Lipid profile - HbA1C and fasting glucose - Other tests: - Diabetic neuropathy: monofilament test - Diabetic nephropathy: ACR (albumin-creatinine ratio), eGFR, UEC - Diabetic foot: pedal pulses - Diabetic retinopathy: visual acuity tests - Refer to specialist for further examination - Pharmacology: - First-line: metformin - Review after 3 months, if glycaemic target <7% not reached consider adding second agent: - GLP-1 agonist: most reduction in HbA1c, cardioprotective, promotes weight loss - SGLT-2 inhibitor: renal and cardioprotective

Answer 34

- Symptomatic (hyperadrenergic symptoms): first-line beta blockers - Definitive therapy: - Antithyroid drugs (e.g. methimazole): first-line for Graves - Radioactive iodine ablation: preferred for toxic MNG or adenoma - Thyroid surgery (e.g. thyroidectomy or lobectomy): preferred for thyroid malignancy or large goitres

Answer 35

- Hypothyroidism: treated with lifelong hormone substitution - Levothyroxine: first-line choice - Levothyroxine titrated with the goal of normal TSH levels - High TSH value (suggest low T4 activity): requires dose increase - Low TSH value (suggests high T4 activity): requires dose decrease

Answer 36

- Hormone replacement therapy: - Primary AI: glucocorticoid +/- mineralocorticoids, androgens - Secondary AI: replacement for hypocortisolism and hypoandrogenism - Treatment of underlying causes: - Malignancy: tumour resection - Hypopituitarism: substitute other hormones - Stress-dose steroids: - dose should be increased to prevent adrenal crisis in at-risk patients (e,g, in acute illness, surgery, trauma)

Answer 37

- Consult an endocrinologist - First-line treatment: tumour resection - Primary hypercortisolism: adrenalectomy - Cushing’s: resection of the pituitary (hypophysectomy) - Adjunctive therapy - Monitor for recurrence - Glucocorticoid replacement therapy often necessary

Answer 38

- Surgical intervention - Adrenalectomy for unilateral adenoma, carcinoma, or adrenal hyperplasia - Correct hypokalemia prior to surgery - Pharmacological management: - Indication: bilateral hyperaldosteronism - Spironolactone (aldosterone receptor antagonist) - Reducing blood pressure - Limiting end-organ damage

Answer 39

- Empiric glucocorticoid and mineralocorticoid replacement - Fluid resuscitation: IV saline - IV dextrose: if hypoglycemic - Identify and treat underlying cause - Consider higher-level monitoring: ICU

Answer 40

- Fluid resuscitation: - IV 0.9% NaCl for first hour - Correct for sodium and glucose as needed - Potassium repletion: if K<5.3 - Insulin therapy: short-acting insulin when K≥3.3 - Identify and treat the precipitating cause (e.g. undiagnosed T1D, infection, surgery, trauma) - Admit to ICU and monitor for resolution of hyperglycemic crises - Monitor pH, glucose, osmolality, anion gap, ketones, and electrolytes (K+, Ca2+, Mg2+, PO43-)

Answer 41

- Avoid known triggers: e.g. tobacco, alcohol - Acute treatment: - 100% oxygen - Triptans (e.g. sumatriptan) - Prophylaxis: verapamil (first-line)

Answer 42

- Non-pharmacological: - Lifestyle and behavioural modification - Psychobehavioral treatments (e.g. CBT, relaxation training) - Pharmacological: - Episodic: NSAIDs, paracetamol - Chronic: amitriptyline (prophylaxis)

Answer 43

- Supportive therapy - Limit stimuli and activity - Treat nausea and vomiting: fluids, antiemetics - Mild-moderate: NSAIDs or paracetamol (PO or IV) - Moderate-severe: - Migraine-specific agents: triptans

Answer 44

- Induction: high-dose glucocorticoid - Maintenance glucocorticoid therapy

Answer 45

- Induction: high-dose glucocorticoid - Maintenance glucocorticoid therapy

Answer 46

- Symptomatic: - Incomplete eye closure: eye ointment, artificial tears - Incomplete mouth closure: proper lip and mouth care - Targeted treatment: - Oral glucocorticoids: start within 48-72h of onset - Consider adding antivirals (e.g. acyclovir) - For secondary palsy: treat based on cause (e.g. herpes zoster, stroke, MS)

Answer 47

- Patient stabilization - Airway management: consider intubation if low GCS or signs of cerebral herniation - Hemodynamic support: fluids and/or vasopressors - Reverse any coagulopathy - Treat any elevated ICP - Empirical therapy - Antibiotics (suspected bacterial cause) - Depends on age group and individual patient risk factors and comorbidities - Common regimen for adults: IV ceftriaxone + dexamethasone - Add benzylpenicillin to cover >50y, immunocompromised to treat Listeria - Add vancomycin if S. pneumoniae indicated - Antivirals (suspected HSV, VZV, EBV): acyclovir - Change to target therapy after results of CSF MCS

Answer 48

- Approach: - Stanford A dissection: immediate surgery - Stanford B dissection: treat conservatively unless complications occur - Supportive therapy: - Analgesia as needed (e.g. morphine) - Control blood pressure: - Hypotensive patients: IV fluids, vasopressors - Hypertension: control tachycardia, start with IV beta blocker/CCBs before adding vasodilator (e.g. esmolol + sodium nitroprusside) - Surgical procedure: aortic stent or graft implantation

Answer 49

- Medical therapy: - BP control with beta blockers - Appropriate medical management of other CVD risk factor (diabetes, hyperlipidemia) - Lifestyle changes: smoking cessation - Asymptomatic: - Aneurysm surveillance: repeat US based on aortic diameter size - Consider elective aneurysm repair - Symptomatic: - Urgent vascular team consult - Signs of rupture (hypotension, severe pain, pulsatile mass): emergency aneurysm repair within 90min - Large-bore IV access, IV hemodynamic support, fluid resuscitation - No signs of rupture: Urgent aneurysm repair and consult anesthesia

Answer 50

- Supportive therapy: - Respiratory support: upright position, high-flow oxygen - Analgesics for pain relief - Depends on patient condition - Stable: - Repeat CXR and monitor for improvement - If enlarging appearance, consider chest tube placement - Unstable and/or traumatic - Emergency needle thoracostomy, followed by chest tube placement - Note: always check CXR to assess chest tube placement

Answer 51

- Acute management of seizures: - Stabilisation: - Call for help and remove or control hazards - Perform ACBDE assessment - Assess and manage rapidly reversible causes of seizures (hypoglycaemia, hyponatremia, hypocalcemia, hyperthermia, alcohol withdrawal) - Pharmacological management: - Early seizure (<5min): usually self-limiting - Status epilepticus (>5min) - IV benzo or IV valproate - If refractory: consider induction of coma - Long-term management: - Remove cause or provoking factors (e.g. recreational drugs, treatment of underlying disorders) - Assess for risk of recurrence: brain imaging for CNS lesion, EEG - Consider starting long-term antiepileptic drugs (e.g. lamotrigine)

Answer 52

- Primary survey and stabilisations - Prehospital trauma care (e.g. spine immobilization, analgesics) - Maintain BP and respiratory control - Measure GCS and pupillary response - Secondary survey - Continuous monitoring - vitals, SpO2, serial neuro exams - Emergency neurosurgery consult if GCS<12 or deteriorating - Intubate if GCS<8 - Consider surgical procedures (e.g. craniotomy and hematoma evacuation) - Neuroimaging (e.g. CT-non contrast, MRI, etc) - Supportive care: - DVT prophylaxis - Antibiotic prophylaxis: consider in patients with open head injuries - Seizure prophylaxis: indicated for severe TBI

Answer 53

- Identify and treat compressive spinal emergencies immediately (e.g. cauda equina, conus medullaris) - Otherwise, start with conservative management: - Physiotherapy, continuation of daily activities, analgesics (e.g. NSAIDs) - Consider injection of local anaesthetics and glucocorticoids to affected region for severe pain - Surgical therapy: - Indications; - Urgent: signs of neuro deficits, bowel or bladder incontinence, compressive emergencies - Elective: failed conversative management - Procedure: discectomy - removal of herniated portion of disc

Answer 54

- Lifestyle management: - Exercise and weight loss - Referral to physiotherapist and/or occupational therapist - Pharmacotherapy: - topical or oral NSAIDs, opioids - Intraarticular glucocorticoid injections - Surgical management: partial or total arthroplasty

Answer 55

- Acute treatment: - Glucocorticoids: oral prednisone - Intraarticular glucocorticoid injections - Symptomatic management: NSAIDs, celecoxib - Long-term management: - Monotherapy with DMARD (e.g. methotrexate) - Consider short-term use of steroids for acute flare-ups and symptom control - Supportive therapy - physical and occupational therapist - heat or cold packs - Surgical therapy: arthroplasty, synovectomy, etc

Answer 56

- Lifestyle management: - Avoid or reduce known triggers: alcohol, seafood, etc - Rest and ice affected joints - Acute management: NSAIDs, steroids, colchicine - Long-term management: ULTs (e.g. allopurinol) - Administer anti-inflammatory prophylaxis before initiating ULT

Answer 57

- Lifestyle management: - optimize calcium and Vit D intake - Encourage physical activity - Avoid or minimize use of tobacco, steroids, alcohol - Fall prevention - Identify and manage any risk factors for falls (e.g. dementia, medication etc) - Refer to physiotherapist and occupational therapist - Pharmacological therapy: - Bisphosphonates: consider risk of esophagitis - Denosumab injections

Answer 58

- Conservative management: - Rest and activity modification - Wrist splinting - reduce pressure on nerve - Analgesics: corticosteroid injections - Surgical intervention: Carpal tunnel release surgery

Answer 59

- Optimize patient education and supportive therapy for all patients. - Consider adding pharmacotherapy for severe pain - Engage a multidisciplinary team for patients who do not achieve adequate relief.

Answer 60

- Low-dose oral glucocorticoids - Usually rapid relief (2-4 weeks)

Answer 61

- Acute management: - Native joints: - Therapeutic arthrocentesis, repeat as often as needed - Synovial fluid analysis after each aspiration - to monitor improvement - Prosthetic joints: surgery to remove pus and infected tissue - Empirical antibiotics - Choice depends on suspected etiology: - Staphylococcal (gram-positive in clusters): IV flucloxacillin or vancomycin (if MRSA) - Streptococcal (gram-positive in chains) or gram-negative: IV ceftriaxone - Change into targeted therapy after MCS

Answer 62

- Approach: - Assess for signs of sepsis and manage accordingly - If imaging and blood cultures are inconclusive - consider bone biopsy - Consider referral to ID specialist - Antibiotic: - Empiric antibiotic rarely required - Pathogen-directed antibiotics based on culture results for 4-8 weeks - Surgical intervention: debridement, amputation in severe cases

Answer 63

- Supportive therapy - Eyelid hygiene - saline irrigation, avoid touching eyes, hand hygiene - Warm or cold compresses - Stop using contact lenses - If bacterial: topical antibiotics (e.g. azithromycin, ciprofloxacin)

Answer 64

- Referral to ophthalmologist - Definitive management: surgery - replacing old lens with an intraocular lens implant

Answer 65

- Emergency ophthalmology consultation - Supportive therapy: analgesics, antiemetics - Pharmacotherapy: administer the following in succession, 1min apart - Direct sympathomimetic: pilocarpine - Alpha-2 agonist: apraclonidine - Beta blocker: timolol - PLUS a systemic carbonic anhydrase inhibitor (e.g. acetazolamide) - Interventional therapy: - Anterior chamber paracentesis - drainage of aqueous humor - Laser peripheral iridotomy

Answer 66

- Pharmacotherapy: - First-line: topical latanoprost (prostaglandin analogs) - Alternative: topical beta blockers - Interventional therapy: - Laser trabeculoplasty - Surgical trabeculectomy

Answer 67

- Lifestyle management: - Avoid triggers of flares - Maintain skin hydration - Stress management - supportive psychotherapy - Based on severity: - Very mild: Non-pharmacological therapy (e.g. moisturizers) - Mild-moderate: Consider adding topical steroids - Moderate-severe: - Escalate non-pharmacological therapy (e.g. wet wrap therapy) - Increase potency of topical steroids - Consider adding systemic therapy: - Phototherapy (UV light) - Systemic steroids - Treatment of acute flare: topical or oral (for severe) corticosteroids

Answer 68

- Based on severity: - Mild (3-5% BSA): topical steroids/retinoids or targeted phototherapy - Moderate-severe (>5% BSA): - Systemic pharmacotherapy - e.g. biologics, such as adalimumab - And/or phototherapy (e.g., narrow UVB) - Supportive therapy: - Skin hydration with moisturizers - Reduce alcohol consumption and smoking cessation - Complications - Psoriatic arthritis: DMARDs (e.g. methotrexate), NSAIDs, intraarticular corticosteroids

Answer 69

- <72h onset: start oral antiviral therapy (e.g. acyclovir) - >72h onset: - If new vesicles still appear: oral antiviral therapy - No new vesicles: supportive care (analgesia and proper wound care)

Answer 70

- Surgical excision: full-thickness with appropriate safety margins - 0.5-1cm for melanoma in situ

Answer 71

- **Surgical excision** of the lesion along with a rim of normal skin - Cryotherapy may be used in cases of carcinoma in situ - Radiotherapy or chemotherapy: for high-risk features or metastasis

Answer 72

- Inpatient treatment if failed outpatient treatment, medically or psychologically unstable, risk to self or others - Non-medical - Psychotherapy: CBT or interpersonal therapy to address negative thoughts and develop coping skills - Lifestyle changes and social support - Medical - Antidepressants (SSRIs or SNRIs) - Follow-up with GP or psychiatrist for assessment of clinical response and dose adjustment

Answer 73

- Inpatient treatment if failed outpatient treatment, medically or psychologically unstable, risk to self or others - Non-Medical Management: - Psychoeducation: Dialectical behavior therapy (DBT) - Mood Tracking: Monitor mood, energy, and sleep patterns to identify patterns. - Lifestyle Routines: Establish stable daily routines for stability and balance. - Consider using a case manager to assist patients with accessing care and support services - Medical Management: - **Medications: usually not indicated** - May consider mood stabilizers and/or atypical antipsychotics for symptom management - Referral to a psychiatrist for ongoing medication and plan management

Answer 74

- Inpatient treatment if failed outpatient treatment, medically or psychologically unstable, risk to self or others - Pharmacological: - Acute mania: atypical antipsychotics (e.g. quetiapine, aripiprazole) - Atypical antipsychotics are frequently used for management of acute mania due to its rapid onset of action. - Stop once acute mania symptoms remit and patient is euthymic - Bipolar I: mood stabilizers (e.g. lithium, valproate) for 6-12m - After starting, recheck lithium/valproate serum levels to ensure it is within therapeutic range. - Non-pharmacological: CBT or psychoeducation by GP or psychologist - Follow-up: medication control can be managed by GP or referred to a psychiatrist

Answer 75

- Biological - Offer medical detoxification services for severe withdrawal syndrome (e.g. Turning Point, DirectLine) - GP to monitor for any physical health complications resulting from substance use - Psychological - Psychotherapy and counselling to provide for relapse prevention strategies, coping skills, and stress management - Screening and treatment of concurrent psychiatric symptoms (e.g. psychosis, mood issues, etc) - Social - Lifestyle modification - regular exercise and sleep hygiene - Social support groups and peer networks - Access to community and social resources (e.g. job, housing)

Answer 76

- Inpatient treatment if failed outpatient treatment, medically or psychologically unstable, risk to self or others - Non-medical - Psychotherapy: CBT or interpersonal therapy to teach coping strategies and challenge negative thought patterns - Lifestyle changes and social support - Medical - Antidepressants (SSRIs or SNRIs) - Inform patients clinical response might occur after 4 weeks - Follow-up with GP or psychiatrist for assessment of clinical response and dose adjustment

Answer 77

- Inpatient treatment if failed outpatient treatment, medically or psychologically unstable, risk to self or others - Non-medical - Psychotherapy: CBT or interpersonal therapy to teach coping strategies and challenge negative thought patterns - Lifestyle changes and social support - Medical - Antidepressants (SSRIs or SNRIs) - Inform patients clinical response might occur after 4 weeks - Follow-up with GP or psychiatrist for assessment of clinical response and dose adjustment

Answer 78

- Inpatient treatment if failed outpatient treatment, medically or psychologically unstable, risk to self or others - Non-medical - Psychotherapy: CBT or ERP (Exposure and Ritual Prevention) - exposed to situations that trigger obsessions, and are taught strategies to prevent the compulsive response - Lifestyle changes and social support - Medical - Antidepressants (SSRIs or SNRIs) - Inform patients clinical response might occur after 4 weeks - Follow-up with GP or psychiatrist for assessment of clinical response and dose adjustment

Answer 79

- Inpatient treatment if failed outpatient treatment, medically or psychologically unstable, risk to self or others - Non-medical - Psychotherapy: trauma-focused CBT - Lifestyle changes and social support - Medical - Antidepressants (SSRIs or SNRIs) - Inform patients clinical response might occur after 4 weeks - If there is poor response or tolerability, the patient should be switched to another first- or second-line agent. - **For individuals with PTSD-associated nightmares**: - [Prazosin](https://www.psychdb.com/meds/alpha-1-antagonist-blocker/prazosin) can reduce trauma nightmares and improve sleep quality. - Follow-up with GP or psychiatrist for assessment of clinical response and dose adjustment

Answer 80

- Identify and manage any complications: - Seizures: IV benzodiazepines (e.g. lorazepam, oxazepam, temazepam) - Psychosis: low-dose antipsychotics (e.g. haloperidol) - Delirium: High-dose IV benzo - Supportive care: - Hydration: IV fluid therapy and fluid balance assessment - Metabolic and nutritional support: - Folate and thiamine supplementation - Electrolyte repletion - Assess and manage comorbidities (e.g. GI bleeding, sepsis, alcoholic hepatitis, etc.) - Follow-up and treatment of alcohol use disorder - Therapy and counselling (see drug use mx) - Pharmacotherapy: Naltrexone, Acamprosate - Management of comorbidity and micronutrient levels

Answer 81

- Empirical antibiotics (against GAS and S. aureus) - E.g. oral cephalexin, IV ceftriaxone - Supportive therapy: elevation of affected limb, analgesics

Answer 82

- Pharmacological: antidementia medications: - Cholinesterase inhibitors: donepezil, galantamine - NMDA-receptor antagonist: memantine 9for moderate-to-severe AD) - Supportive therapy - Maintain predictable schedule, familiar home environment - Assess need for home care package and liaise with social care worker - ACAS assessment - Assess need for move to RCAF for more involved level of care - Management of BPSD - First-line: non-pharmacological interventions - Assess and address any possible causes of agitation (e.g. incontinence, pain, etc) - Diversional therapy - physical, cognitive, sensory activities - Sleep hygiene - Medication review

Answer 83

- Pharmacological: antidementia medications: - Cholinesterase inhibitors: donepezil, galantamine - NMDA-receptor antagonist: memantine 9for moderate-to-severe AD) - Supportive therapy - Maintain predictable schedule, familiar home environment - Assess need for home care package and liaise with social care worker - ACAS assessment - Assess need for move to RCAF for more involved level of care - Management of BPSD - First-line: non-pharmacological interventions - Assess and address any possible causes of agitation (e.g. incontinence, pain, etc) - Diversional therapy - physical, cognitive, sensory activities - Sleep hygiene - Medication review

Answer 84

- Acute management: - Primary assessment - Analgesia (oral, parenteral, and especially region, such as fascia iliaca block) - Pre-op assessment: - Basic pre-op work up (FBE, UEC, coagulation profile, group and hold, ECG) - Fitness for surgery: identify and treat any comorbidities (e.g. diabetes, anticoagulation) - Capacity to consent - Consider fasting time and fluid management - Operative management: type of surgery depends of fracture type, displacement, etc - Fixation using a dynamic hip screw, partial hip replacement, THR - Peri-operative management - Prevention of complications (e.g. VTE, pressure ulcers, delirium) - Weight-bearing status and urge early mobilisation - Minimize interventions (IV, IDC, etc) - Long-term management: - Falls and fracture prevention (OT referral and home modification, Vit D supplement, etc) - Physiotherapy - strengthening muscle and mobility rehabilitation - Patient and family support and education

Answer 85

- Supportive care: - Rehabilitation: involve physiotherapy for gait and balance training - Falls prevention and education - Advanced care planning: - prognosis and end-of-life choices should be discussed early - consider referral to palliative care for symptom management - Pharmacological treatment - First-line: Levodopa, a dopamine agonist - Inform patient of potential side effects (e.g. dyskinesia) and to avoid sudden discontinuation - Treatment of associated symptoms: - MDD: treat with antidepressants (SSRIs, SNRIs) - Dementia: rivastigmine (cholinesterase inhibitor) - Autonomic dysfunction: based on presentation - Sleep disorders: improve sleep hygiene, consider melatonin

Answer 86

Oxygen: Maintain oxygen saturation above 94%. Intravenous fluids: Administer fluids to restore and maintain adequate circulating volume. Blood cultures: Collect blood samples for culture. Intravenous antibiotics: Administer broad-spectrum antibiotics promptly. Urine output measurement: Monitor and document urine output. Serum lactate: Measure lactate levels to assess tissue perfusion.