Management Plans

Question 1

Acute Heart Failure

Answer 1

Sit patient up
O2
IV Furosemide

Consider Opioids

Question 2

Acute Heart Failure - if inadequate response

Answer 2

Isosorbide Dinitrate Infusion
+/- CPAP

ICU transfer

Question 3

Chronic Heart Failure

Answer 3

Lifestyle
ACEi and BBs
Aldosterone Antagonist

Question 4

Chronic Heart Failure - refer to specialist for

Answer 4

Digoxin 
Ivabradine 
Amiodarone 
Sacubitril + Valsartan 
Hydrasalazine + Long acting nitrate

Question 5

STEMI

Answer 5

Morphine IV 2.5-5mg
O2
Nitrates
Antiplatelet Therapy

PCI

Question 6

STEMI/NSTEMI Antiplatelet therapy

Answer 6

Aspirin 300mg

Ticagrelor 180mg

Question 7

NSTEMI

Answer 7

Morphine IV 2.5-5mg
O2
Nitrates
Antiplatelet therapy

LMWH
PCI

Question 8

TIA

Answer 8

CT head (rule out haemorrhagic stroke)

Aspirin 300mg OD PO until dx established

Question 9

Ischaemic Stroke

Answer 9

CT head (rule out haemorrhagic stroke)

Alteplase 900 micrograms/kg (max 90mg)

Question 10

Ischaemic Stroke - Alteplase Administration

Answer 10

900 micrograms/kg (max 90mg)

Must be given within 4.5 hours of symptom onset over 1 hour

Initial 10% of dose = IV injection
Remaining 90% of dose = IV infusion

Question 11

Ischaemic Stroke - if Alteplase is not appropriate/after Alteplase

Answer 11

Aspirin 300mg OD for 14 days

Initiate 24 hours after thrombolysis
OR
Within 48 hours if no thrombolysis

Question 12

Stable Angina

Answer 12

Sublingual GTN PRN 
Secondary prevention (Aspirin and Statin)

Question 13

Stable Angina Initial Treatment Options

Answer 13

BB
OR
CCB

Question 14

Stable Angina Treatment Options if CI

Answer 14

Long-acting Nitrate

Refer to specialist if 2 medications fail to control symptoms

Question 15

AF Rate

Answer 15

Atenolol 50-100mg OD
OR
Digoxin

Question 16

AF Rhythm (<48 hours)

Answer 16

Electrical Cardioversion

Chemical Cardioversion with Amiodarone

Question 17

AF Chemical Cardioversion with Amiodarone

Answer 17

Amiodarone 5mg/kg (max 1.2g OD)

Given over 20-120 minutes
ECG monitoring

Question 18

AF Thromboprophylaxis

Answer 18

CHA2DS2VASc and HASBLED

Offer DOAC if >2 (Apixaban 5mg BD)

Question 19

Asthma Acute Exacerbation

Answer 19

O2 
Salbutamol 5mg Neb
IV Hydrocortisone 100mg OR Prednisolone 40mg 
Ipatropium Bromide 500 Mcg Neb
MgSO4 2g IV 
Aminophylline 

ITU Transfer

Question 20

COPD Acute Exacerbation

Answer 20

O2 
Salbutamol 5mg Neb 
Ipatropium Bromide 500 Mcg
Prednisolone 30mg (for 5 days)
Theophylline +/- NIV 

ITU transfer

Question 21

PE

Answer 21

Wells Score to calculate probability

<4 D-Dimer
>4 CTPA and interim anticoagulation

Question 22

Epileptic Fit

Answer 22

Position patient to avoid injury

ABCDE - O2, correct low glucose

Question 23

Seizures >5 minutes

Answer 23

IV Lorazepam 4mg

Repeat once after 10 minutes if still fitting.

Question 24

Seizure >5 minutes and no IV access

Answer 24

Diazepam 10mg PR

Midozalam Buccal

Question 25

Seizure >5 minutes with 2 BZD doses

Answer 25

Start loading dose of phenytoin ITU

Question 26

Meningitis

Answer 26

Admit Single dose IM Benzylpenicillin 1.2 grams if community and sepsis Empirical = IV Ceftriaxone Encephalitis or viral meningitis = IV Aciclovir

Question 27

Upper GI bleed

Answer 27

IV Crystalloids - 0.9% NaCl, Hartmann's, Plasmalyte | Blood transfusion +/- FFP

Question 28

Variceal bleed

Answer 28

Terlipressin (dose depends on body weight) | Prophylactic Abx

Question 29

Upper GI bleed - do not routinely give

Answer 29

Platelet transfusion | PPI

Question 30

Upper GI bleed - platelet transfusion given ONLY if

Answer 30

Actively bleeding | Platelet count <50 x10^9/L

Question 31

Ulcerative Colitis

Answer 31

Prednisolone 20-40mg daily until remission Mesalazine can be used for induction in mild cases/remission Azathioprine Ciclosporin Biologics

Question 32

Crohn's Disease - Inducing Remission

Answer 32

Prednisolone 20-40mg +/- Azathioprine +/- Methotrexate +/- Biologics

Question 33

Chron's Disease - Maintaining Remission

Answer 33

Azathioprine OR Mercaptopurine +/- Methotrexate

Question 34

Gout - Acute Flare

Answer 34

NSAIDs Colchicine 500 mg 3rd line = Corticosteroids

Question 35

Gout - Prophylaxis

Answer 35

Lifestyle Allopurinol 100mg OD PO (titrate, take after food) Febuxostat 80mg OD PO (titrate)