Emergencies
Other than adrenaline, name two other treatments that can be given in the event of anaphylaxis.
Salbutamol, fluids (normal saline), oral prednisolone (if indicated)
Interpret these results:
HCV-antibody: Positive
HCV RNA: Negative
Likely past resolved infection of Hep C
What is the most common type of headache?
Tension type headache
If a patient is requiring repeat IM adrenaline in anaphylaxis, what other method of delivery might you consider?
Double points if you can explain how you would prepare and deliver it.
Adrenaline infusion: mix 1mL of 1:1000 adrenaline with 1000mL of normal saline
Start at 5mL/kg/hr rate and titrate based on response
Describe the step-down therapy for PPI treatment in patients with GORD
1. Reduce dose of PPI or use on alternate days
2. On-demand PPI (use on days they have symptoms)
3. Trial cessation of PPI
Name at least 4 causes of secondary headache
Space occupying lesion e.g. tumour, abscess
Hydrocephalus
Intracranial bleed/stroke
Trauma
Infection e.g. meningitis, encephalitis
Hypertension
Sinusitis
Trigeminal Neuralgia
Temporal Arteritis
TMJ pain
OSA
Glaucoma
Middle ear infection
Resp virus e.g. influenza
etc.
In case of anaphylaxis, how many mL of a 1:1000 solution of adrenaline would you give an adult or child >12 years of age ( and >50kg)? (1mL contains 1mg of adrenaline)
0.5mL
A patient presents with first degree haemorrhoids. What lifestyle changes would you recommend to this patient (at least 3) and what options for symptom relief would you offer them (at least 1)?
Lifestyle:
- Avoid constipation (drink water, high fibre diet, fibre supplements, mild laxatives, avoid drugs that cause constipation)
- Avoid straining
- Shorten length of time spent sitting on the toilet
- Go when you feel the urge, don't hold it
- Avoid caffeine
- Use wet wipes or wet toilet paper to wipe
Symptom relief:
Haemorrhoid cream - hydrocortisone, LA
Sitz bath
Name the three types of primary headache, and describe the typical features of each that would help you differentiate them.
Tension Headache - cervical tenderness, tight band around the forehead or pain radiating from the neck (bilateral, mild to moderate pain non-pulsating pain)
Migraine - unilateral, pulsating, moderate to severe pain, affected by position and movement, with or without aura, nausea and vomiting, photophobia and phonophobia
Cluster Headaches - unilateral, severe, 'boring' pain behind one eye, ipsilateral watery red eye, nasal congestion and discharge
Name at least 2 risk factors for increased severity or fatality of anaphylactic reaction
Asthma/respiratory comorbidity
Cardiovascular disease
Concurrent use of B-blockers or ACE-i
Triggered by peanuts
Triggered by antibiotics or anaesthetics
Name 4 lifestyle changes for the management of GORD symptoms
Avoid foods or drinks that trigger symptoms (e.g. spicy foods, caffeine, carbonated drinks)
Avoid large or late meals, and avoid lying down immediately after eating.
Raise the head of the bed (if symptoms are worse at night and disrupt sleep)
Lose weight
Reduce alcohol intake
Stop smoking
Name two specific signs on physical examination (NOT symptoms) that suggest a patient could have meningitis.
Extra points: explain how to test for each of these signs (100 points for each correct explanation)
How can you differentiate the severity of an asthma exacerbation - mild/moderate, severe, life threatening? How does initial management differ for each of these presentations?
Mild/Moderate: Can walk and speak in full sentences
Mx: 4-12 puffs of salbutamol
Severe: Any of: unable to speak in sentences, visibly breathless, increased work of breathing, oxygen saturation 90–94%
Mx: 12 puffs of salbutamol + 8 puffs of ipatropium OR 5mg of salbutamol and 500mcg of ipatropium via intermittent nebulisation
Start oxygen and titrate to SaO2 93-95%
Life threatening: Any of: drowsy, collapsed, exhausted, cyanotic, poor respiratory effort, oxygen saturation less than 90%
Mx: Salbutamol 2x 5mg nebules via continuous nebulisation + oxygen
ARRANGE TRANSFER TO HIGHER LEVEL CARE
Name any 5 red flags that would indicate the need for further investigation in a patient with symptoms of Irritable Bowel Syndrome:
Recurrent abdominal pain:
- Related to defecation
- Associated with a change in the frequency of stool
- Associated with a change in the appearance (form) of stool
Age over 50 with recent change in bowel habit
Melaena or haematochezia (overt bleeding)
Nocturnal pain or passage of stools
Unintentional weight loss
FHx of colon cancer or IBD
Palpable abdominal mass
Iron deficiency
Positive faecal occult blood test
Describe in detail how you would manage chronic migraines, including acute and long term management, and non-pharmacological and pharmacological approaches
Acute - pharm: Panadol, Triptans, NSAIDs, anti-emetic if severe nausea and vomiting
Acute - non-pharm: Lie down in a dark room, stay hydrated, cool compress
Long term - pharm: Propanolol or amitriptyline
Long term - non-pharm: Avoid triggers, migraine diary, maintain a healthy body weight and exercise