PSA- common conditions

Question 1

management of chronic asthma

Answer 1

1) SABA eg salbutamol
2) Inhaled corticosteroid
3) LTRA-montelukast
4) LABA-eg salmeterol (stop LTRA if not helping)
5) MART- maintenance and release therapy- ICS plus fast acting LABA
6) theophyline/ tiotropium

Question 2

side effects of salbutamol/ SABA

Answer 2

hypokalaemia

arrhythmia, tremor, palpitations, headache

Question 3

drugs not to prescribe in asthma

Answer 3

NSAIDs- bronchospasm

betablockers-

adenosine (also CI in COPD)

Question 4

management of acute asthma

Answer 4

1) Oxygen
2) SABA
3) Steroid- oral pred/ IV hydrocortisone
4) Nubuslied ipratropium bromide
5) magnesium sulphate
6) IV aminophyline

Question 5

loading dose of aminophyline in acute asthma?

Answer 5

5mg/kg SLOW IV injection over at least 20 mins

available in 25mg/ml ampules

Question 6

target plasma concentration of aminophyline

when to measure aminiphylline concs?

Answer 6

10-20 micrograms/mL

measure 18 hours after starting treatment or sooner if concerns about toxicity

Question 7

Management of chronic COPD

Answer 7

Stop smoking, flu vaccine and pneumococcal vaccine, pulmonary rehabilitation

1) SAMA (ipratropium bromide) / SABA (salbutamol)
2) determine whether asthmatic features and steroid responsive

NO ASTHMATIC FEATURES/ NOT STEROID RESPONSIVE

3) LABA +LAMA (tiotropium), (stop SAMA)
4) ICS

STERIOD RESPOSIVE/ ASTHMATIC

3) LABA+ ICS- fostair, symbicort, seretide
4) LABA+ LAMA+ ICS (stop SAMA)

prolonged or frequent infective exacerbations:
prophylactic azithromycin

Question 8

management of exacerbation of COPD

Answer 8

AT HOME

1) Prednisolone 30mg once daily for 7-14 days
2) Regular inhalers or home nebulisers
3) Antibiotics if there is evidence of infection

IN HOSPITAL

1) Nebulised SABA/ SAMA
2) IV/PO steroids
3) antibiotics- amoxicillin/ doxycyline
4) physio
5) IV aminophylline
6) NIV
7) intubation and ventilation

Question 9

Target saturations for COPD

Answer 9

88-92%

Venturi 28% mask, 4L, until blood gases can be measured to determine of retaining CO2

Question 10

Management of angina

Answer 10

ACUTE

• GTN (glyceryl trinitrate)
• repeat after 5 mins, call ambulance if pain still present after another 5 mins

LONG TERM
1)betablocker- atenolol/ bisoprolol
(CCB eg verapimil if CI)
2) BB + CCB (long acting nitrate eg ivabridine if either CI)

SECONDARY PREVENTION OF CARDIOVASCULAR DISEASE

• lifestyle
• low dose aspirin and statin if atherosclerotic disease
• ACE-I if diabetes

Question 11

acute management of unstable angina/ NSTEMI

Answer 11

MONA ABC

• morphine 5-10mg IV
• oxygen if desaturating <96%
• GTN
• Asprin 300mg

ABC

• Anticoagulant- LMWH eg enoxaparin 1mg/kg BD
• Betablocker- continued indefinitely (verapimil/diltaziem if CI)
• Clopidogrel

GRACE Score-
PCI if high risk (NEVER THROMBOLYSIS)

Question 12

Secondary prevention of ACS

Answer 12

6As

Aspirin 75mg OD
Another antiplatelet- clopidogrel/ticagrelor for 12 months
Atorvostatin 80mg OD
ACE-I- ramipril
Atenolol
Aldosterone antagonist if clinical heart failure

plus lifestyle changes

Question 13

acute management of STEMI

Answer 13

MONA

PCI if available <90 mins after diagnosis + LMWH
or
Thrombolysis if not available- streptokinase+ LMHW

A(2)BC
-Anticoagulant (LMWH) +ACE-I (continued for 5-6 weeks)
-Betablocker
-Clopidogrel
D- diabetes- monitor for hyperglycaemia

Question 14

Management of Gastro-oesophageal reflux disease (GORD)

Answer 14

• lifestyle changes
• PPI (lansoprazole)
• if no response after 4-8 weeks–> H2 receptor antagonist (ranitidine)

Question 15

1st line medical treatment of depression

Answer 15

SSRI eg citalopram, fluoxetine, sertraline

Question 16

1st line medicial management of anxiety

Answer 16

SSRI- sertraline

Question 17

Management of urge incontinence

Answer 17

-antimuscarinic- oxybutynin/ tolterodine
-bladder retraining
(mirabegron if concern about antimuscarinic effects in frail older women)

Question 18

management of stress incontinence

Answer 18

• pelvic floor training
• surgical procedures
• duloxetine only if other measures have failed

Question 19

Management of hypertension

Answer 19

WHITE <55 or T2DM ANY AGE or RACE
1)ACE-I
2)ACE-I + CCB
3ACE-I +CCB+ thiazide diuretic

BLACK/ WHITE >55

1) CCB
2) CCB+ thiazide diuretic
3) CCB +thiazide diuretic + ACE-I

Question 20

Management of UTI

Answer 20

trimethoprim/ nitrofurantoin

pregnant women- nitrofurantoin/ amoxicillin

pyelonephritis- ciprofloxacin/ cefalexin

Question 21

Management of pulmonary oedema

Answer 21

Stop IV fluids
Sit up, oxygen if desaturating
Diuretic- IV furosemide 40mg STAT
Monitor fluid balance, U+Es, bloods, daily weight

Question 22

management of Crohn’s disease

Answer 22

inducing remission:
1st line- steroids (oral pred/ IV hydrocortisone)
2nd line- azothiaprine, methotrexate, infliximab

maintaining remission:
1st line: azothiaprine

Question 23

management of ulcerative coliitis

Answer 23

flare

• aminosalicylate
• IV steroids if severe

maintenance

• aminosalicylate
• azothiaprine

Question 24

Management of Parkinson’s disease

Answer 24

if motor symptoms affecting QoL
-levodopa

if not affecting QoL, choice of:

• ropinirole: non-ergot-derived dopamine-receptor agonist
• rasagiline: monoamine-oxidase-B inhibitors
• levodopa

Question 25

Medical management of alzheimers disease

Answer 25

acetylcholinesterase (AChE) inhibitors: donepezil rivastigmine galantamine

Question 26

management of anaphylaxis

Answer 26

500 micrograms adrenaline IM 0.5mls- 1 in 1000 -repeat after 5 mins if no better oxygen IV fluid challenge 500-1000mls chlorphenamine (antihistamine) 10mg IM/IV slowly Hydrocortisone 200mg im/IV slowly

Question 27

DKA management

Answer 27

1) fluid resus- 500ml 0.9% NaCL over 10-15 mins 2) Repeat, add potassium if hypokalaemic 3) Fixed rate insulin infusion- 0.1units/kg/hr, diluted with NaCL- 1 unit/ml 4) Monitor blood ketones, glucose, potassium 5) once blood glucose <14mmol/L- add in glucose 10% 6) continue with insulin infusion until blood ketone <0.3, pH >7.3 and patient can eat and drink--> give SC fast acting insulin and meal

Question 28

drug management of shingles

Answer 28

aciclovir

Question 29

Empirical antibiotics for community acquired pneumonia

Answer 29

CURB 0-1: amoxicillin 500mg TDS/ doxycycline 200mg PO CURB 2: amoxicillin + clarithromycin PO/ IV CURB >3: co-amoxiclav + clarithromycin IV

Question 30

management of pulmonary embolism

Answer 30

prophylaxis in hospital: LMWH eg enoxaparin management: 1)Wells score- >4(likely)--> CTPA for diagnosis (V/Q scan if renal impairment/ contrast allergy) <4 (unlikely)--> D-Dimer 2) Treatment dose LMWH 3)oxygen 4)Switch to long term anti-coagulation (warfarin/ NOAC/ LMWH) 5)thrombolysis if massive PE

Question 31

acne management

Answer 31

1) topical benzyl peroxide 2) topical retinoid- adapalene 3) Topical antibiotic- clindamycin 4) atelaic acid 5) Oral antibiotic- tetracycline eg doxycycline 6) Oral contraceptive pill 7) oral retinoid- isotrenin

Question 32

management of croup

Answer 32

one dose oral dexamethasone (0.15mg/kg) emergency treatment: oxygen and adrenaline

Question 33

management of ear infections

Answer 33

otitis externa- flucoxacillin otitis media- amoxicillin

Question 34

epiglottitis management

Answer 34

secure airway IV antibiotics- cefotaxime/ ceftriaxone dexamethasone