Random 2

Question 1

Adrenally suppressed patients undergoing minor surgery should be managed how, in terms of their steroids?

Answer 1

Take normal steroid dose the morning of surgery, additional steroids not required

Question 2

Adrenally suppressed patients undergoing moderate or major surgery should be managed how, in terms of their steroids?

Answer 2

Take usual steroid dose AND 25-50mg hydrocortisone IV on induction

25-50mg hydro IV tds for moderate surgery for 24 hours and 48-72 hours if major

Question 3

How should OHA be managed the morning of surgery?

Answer 3

RUH tend to omit all OHA

Question 4

How long is post-op VTE prophylaxis usually continued for?

Answer 4

If patients are high risk (i.e. they have one or more risk factors) then should give them LMWH prophylactic dose until mobility restored - consider to hip and knee replacements etc. that extended prophylaxis will be needed.

Question 5

What weak opioid is preferred post surgery?

Answer 5

Dihydrocodeine (PLUS paracetamol as baseline)

codine - non metabolisers and tramadol now a CD

Question 6

Your patient has been prescribed metoclopramide for PONV, when should this be given??

Answer 6

IT SHOULDNT BE - metoclopramide is ineffective for the management of PONV.
Switch patient to dexametasone or ondansetron and give 20-30mins before the end of surgery (therefore given IV)

Question 7

Are antibiotics needed for clean procedures?

Answer 7

NO

Question 8

A patient has AF, no bleeding and an INR of 8.0 - what do you do?

Answer 8

Stop warfarin and restart when INR <5

Question 9

True or False, ACEi increased life expectancy in patients with CHF?

Answer 9

True

Question 10

What are the preferred diuretics for the management of symptoms in CHF?

Answer 10

Loop diuretics

Question 11

TCAs have anticholinergic side effects, give examples

Answer 11

Heart block, urinary retention, constipation, dry eyes

Question 12

SSRIs in combination with MOAI can cause what/?

Answer 12

Serotonin syndrome

Question 13

What is the target TC in patients with ACS started on atorvastatin?

Answer 13

No target

Question 14

True or false - COPD is commonly associated with symptoms at night

Answer 14

False - asthma is though

Question 15

When should alteplase be given in ischemic stroke? What does it target?

Answer 15

4.5 hours - activates tPa

Question 16

What drug is the most frequently implicated in drug induced parkinsons?

Answer 16

Prochlorperazine

Question 17

Why is prochlorperazine a concern in the elderly?

Answer 17

often prescribed for dizziness but can caused PD

Question 18

Warfarin is associated with an increased risk of falls. True or false?

Answer 18

False - warfarin is often witheld (when it should be prescirbed!) because of the risk of falls, we should manage the falls risk instead

Question 19

Dopaminergic drugs, such as co-beneldopa in PD can often have what side effects that are of concern in the elderly?

Answer 19

Can cause sudden excessive daytime sleepiness - careful dose titration required to avoid inducing confusion.

Question 20

What is the ‘active’ thyroid hormone?

Answer 20

T3 (T4 converted to T3 in the peripheries)

Question 21

What does the hypothalamus secrete in terms of thyorid hormone regulation?

Answer 21

TRH

Question 22

Hypo or hyperthyroidism?: Bradycardia

Answer 22

Hypo

Question 23

Hypo or hyperthyroidism?: warm, sweaty skin

Answer 23

Hyper

Question 24

Hypo or hyperthyroidism?: constipation

Answer 24

Hypo

Question 25

Hypo or hyperthyroidism?: weight gain

Answer 25

Hypo

Question 26

Hypo or hyperthyroidism?: AF

Answer 26

Hyper

Question 27

Why are anti-embolic stockings not used routinely in stroke patients?

Answer 27

Ineffective in reducing risk of DVT and increased risk of skin damage. Use intermittent pneumatic stockings instead

Question 28

A blood pressure of 140/80 scores what (in terms of ponts) in the CHA2DSVasc scoring?

Answer 28

0 - BP of >140/90 is considered risk of stroke

Question 29

True or False - Hallucinations is NOT a typical sign of dementia

Answer 29

False - patients with dementia experience hallucinations, agitatation, short term memory loss and often have poor self-care.

Question 30

Why is it important to identify factors that can alter the plasma theophyline concentration (e.g. illness, smoking)

Answer 30

Very narrow therapeutic range

Question 31

TIA management - acute and long term

Answer 31

1. Aspirin 300mg STAT - oral or rectal 2. SALT assessment and confirmation of diagnosis 3. Clopidogrel 300mg loading dose 4. 75mg clopidogrel thereafter 5. Atorvastatin 80mg 6. Manage hypertension - target is 130/80

Question 32

Ischemic stroke management

Answer 32

1. Aspirin 300mg STAT 2. SALT assessment and diagnosis 3. clopidogrel 75mg 4. Atorvasatin 80mg as soon as patient can swallow 5. Antihypertensive if needed target = 130/80

Question 33

ABCD2 score, is used for what? What does it stand for?

Answer 33

Used to assess someone's risk of future stroke following a TIA A- age >60 years B - blood pressure 140/90 C- clinical symptoms - unilateral weakness (2), speech disturbance and no weakness (1), other symptoms (0) D - diabetes (1) or duration of symptoms >59mins (2), 10-59 (1) and <10 is 0.

Question 34

Blood pressure target in pregnancy?

Answer 34

150/90 or 140/90 is diabetic or has CKD

Question 35

Diabetes BP target?

Answer 35

140/90 | lower 130/80 if target organ damage

Question 36

BP target following TIA/Stroke?

Answer 36

130/80

Question 37

Outline some of the issues associated with a person taking long-term steroids (think short and long term)

Answer 37

``` Immunosuppresion Osteoporosis Adrenal suppresion Cushings syndrome Depression ```