Q.3.1 What is the most worrying SE of clozapine
agranulocytosis → if suspected must stop immediately and refer to haematologist.
Q.3.1. Can an asthmatic patint be treated with an NSAID?
If asthmatic patient had no wheeze with (NSAID) ibuprofen, they may continue it – don’t necessarily have to stop it, as means asthma not NSAID sensitive.
Q.3.3 How to check BNF re warfarin/INR
search; oral anticoagulants
Q3.4 What is neutropaenic sepsis and how is it managed
Neutropenic sepsis = any source of sepsis with neutrophils <1.
Most common regimen is piperacillin + tazobactam + gentamicin.
Should go through PReSCRIBER mnemonic and know that R is relief of pain – so needs paracetamol for fever and pain.
Q3.5 How can carbmazepine affect electrolytes
carbamazepine -> SIADH -> hyponatraemia
Q3.6 Rx of UTI in pregnancy
Trimethoprim = folate antagonist CI in pregnancy as predisposes to neural tube defects.
UTI in early pregnancy therefore treated with co-amoxiclav.
Q.3.7 Management of Digoxin in a patient with slow AF
Q.3.7 Addisons disease sick day rules
Addisonian + sick = increase hydrocortisone;
if postural hypotension not present, just means not severe hydrocortisone depletion, so still need increased steroids.
Q.3.8 To remember re writing up regular medications in an acute exacerbation of asthma
Salbutamol inhaler should be stopped whilst being given the same drug by the (more effective) nebulised route.
Q.3.9 Sx or R and L sided HF
R-sided HF = peripheral oedema + raised JVP
L-sided HF = bilateral crepitations + SOB.
Q.3.9 Diuretic options in CCF
Furosemide is mainstay of treatment in acute HF, in acute setting, give 40mg IV.
Bumetanide is another loop diuretic reserved for patients resistant to furosemide.
Bendroflumethiazide uncommonly used to manage chronic HF.
Q3.10 elderly patient with fast AF + asthma + peripheral oedema
Digoxin (as CI BB+CCB)
Beta-blockers (bisoprolol) are CI
CCB (diltiazem) is not recommended in the presence of peripheral oedema as would worsen fluid retention
DC cardioversion only if acute features + cannot be performed if >48h history because of risk of intracardiac thrombus and subsequent stroke with reversion to sinus rhythm. You’d need anticoagulation + echo first.