Random and Driving

Question 1

What kind of fax is zostavax

Answer 1

Live attenuated - don’t give if immune compromised or if on immune suppressant

Question 2

Ideal age for zostavax

Answer 2

70 tô 79 free Anytime after 50 Wait 1 to 3 yrs after infection to be vaccinated

Question 3

Can you give zostavax with flu or pneumonia Vax simultaneously

Answer 3

Yes

Question 4

Young man with ECG demonstrating tall narrow QRS - with LVH - presents with palpitations and dizziness.

Answer 4

Hypertrophic cardiomyopathy Examination - Double or triple apical impulse, double carotid arterial pulse, S3 or S4, Loud murmur - often ejection systolic, A WAVE in JVP, can have displaced forceful apex beat. Can present with SVT or AF In young people can have Sudden cardiac death In older people Heart failure.

Question 5

Examination features for HCM?

Answer 5

Examination - Double or triple apical impulse, double carotid arterial pulse, S3 or S4, Loud murmur - often ejection systolic, A WAVE in JVP, can have displaced forceful apex beat. Can present with SVT or AF In young people can have Sudden cardiac death In older people Heart failure.

Question 6

Why do people collapse in HCM?

Answer 6

Left ventricular outflow obstruction (doesnt occur in all)

Question 7

What symptoms does someone with HCM present with?

Answer 7

Any cardiac - angina, Dyspnea, palpitations, PND, orthopnoea, sudden cardiac death, syncope

Question 8

How do people die in HCM?

Answer 8

Mortality rate is 1% Die of SCM in young In old - Heart failure or stroke

Question 9

What is the inheritance pattern of HCM?

Answer 9

Autosomal dominant

Question 10

Any follow up after a diagnosis of HCM in a dead person

Answer 10

ECG and ECHO and refer to cardiologist for genetic test All FIRST DEGREE RELATIVES MUST BE REFERRED TO CARDIOLOGIST FOR SCREENING

Question 11

What is the differential dx for sudden cardiac death?

Answer 11

STRUCTURAL heart disease vs NON STRUCTURAL 1. HCM 2. Congenital heart disease 3. Arrhythmogenic right ventricular cardiomyopathy 4. Myocarditis 5. CAD Non Strcutural 1. Long QT syndrome 2. Brugada syndrome

Question 12

When should the first degree relatives be reffered to a cardiologist in SCD?

Answer 12

1. If HCM was diagnosed. 2. If negative autopsy - to think about other causes. 3. If no autopsy was done

Question 13

Flying restrictions?

Answer 13

Stroke - not for 3

Heart attack - not for 7

Post surg - not for 10

Needs to medically and mentally fit to sit in confined space in a pressurised cabin with LOW oxygen for several hours

Usu if resting Sp02 is over 95 then ok

Severe resp disease

Acute infections

Unstable chronic diseases

DM - carry sweets;

Colostomy - larger bag

Epileptics may need to increase dose on day of travel

Question 14

Preparing for altitutde sickness when travelling

Answer 14

Slow ascent is key

No more than 500m sleeping elevation a day after initial ascent of 3000 over two days minimum.

If risk of quick ascent or other issues like previous Alt sick or Acute Pul Oedema risk then:

Acetazolamide 125mg BD

COMMENCE DAY BEFORE ASCENT

• _{<strong>Acetazolamide - can cause perioral tingling/flushing/polyurea</strong>}*
• _{<b>C/I is sulphur allergy</b>}*

Question 15

Stable Patient in Regular Ventricular Tachycardia

Answer 15

Amiodarone 300mg IV over 20-60mins

then

Amiodarone 900mg IV over 24 hrs

Question 16

Acute management of SVT

Answer 16

1. Vagal manoeuvres
2. Give adenosine 6mg IV

if unsuccessful 12mg

Question 17

Who does the patient have to inform of medical conditions which might affect driving

Answer 17

Driving licensing authority and GP

You only have to inform DLA if:

Witnessed patient driving against advice

Witnessed patient driving under influence of alcohol

If patient is cognitively impaired and can’t inform or make decision

Question 18

Driving with blackouts of uncertain nature?

Answer 18

Cannot drive till cause ascertained.

If no cause - and ONE blackout

then 6 months of no further episodes for non commercial.

5 years - for commercial.

Two or more

then 12 months

and 10 years respectively.

Question 19

Driving post AMI

Answer 19

2 weeks post AMI in private

4 weeks in commercial

(one week flying)

Question 20

Driving Post PCI

Answer 20

Private - 2 days

Commercial - 4 weeks (same as AMI)

Question 21

Driving Post CABG

Answer 21

1 month Private

3 months Commercial

Question 22

Driving post Angina

Answer 22

Conditional driving license for both with approval from treating specialist

Question 23

Diabetes and driving

Answer 23

Any commercial driver must see specialist for approval YEARLY (regardless of which meds they are taking)

A private driver - Needs 5 yearly GP review (not on insulin)

2 yearly GP review (on insulin)

Question 24

Hearing and driving

Answer 24

No standard for private

In commercial hearing loss over 40 Db requires hearing testing

Question 25

Patient with dementia who is driving

Answer 25

Discuss risks and benefits They must inform DLA They will need to stop driving at some point If patient chooses to continue driving - then assess whether cognitive/other risks are too great to continue and advise patient to either a) continue driving till decision from DLA or b) stop until decision from DLA has been made.

Question 26

Seizures and driving

Answer 26

ONE year seizure free period for private TEN year seizure free period for commercial

Question 27

Vision and driving

Answer 27

Private one eye at least 6/12 - otherwise opthalm ref Commercial one eye 6/9 and other at least 6/18 - otherwise opthalm ref