For Afro-Caribbean patients with T2DM it should be an ARB given in preference to ACEi as due to ethnicity they have poorer response to ACEi - this is in NICE guidance :)
In this section, it is of extreme importance to use the BNF. Therefore I would love to see advice on how to search for info in the BNF since Y5 Medical students are not able to know specific indications and doses. All other info provided here is very useful but strategic advice is not provided
For the fluids question, initial potassium replacement should not involve glucose. This is because glucose may cause further decrease in the plasma-potassium concentration
Because of the haemodynamic instability the approach in management is different. From NICE: "Anticoagulation treatment for PE with haemodynamic instability 1.3.12 For people with confirmed PE and haemodynamic instability, offer continuous UFH infusion and consider thrombolytic therapy (see the section on thrombolytic therapy). [2020]" From BNF entry for apixaban: "Apixaban should not be used as an alternative to unfractionated heparin in pulmonary embolism in patients with haemodynamic instability, or who may receive thrombolysis or pulmonary embolectomy"
@@tammy8779 I am sure you'll do great! If you have a physical BNF, Appendix 1 (Page 1443 in the current version BNF) has drug interactions, usually a few easy marks to gain for questions like 'which of these drugs causes hyponatraemia'
For the third question, shouldn't the first dose of the ACE inhibitor be taken before bed due to the falls risk due to reflex hypotension? Then from the second dose onwards the medication can be taken at any time consistently that the patient wants?
For Afro-Caribbean patients with T2DM it should be an ARB given in preference to ACEi as due to ethnicity they have poorer response to ACEi - this is in NICE guidance :)
In this section, it is of extreme importance to use the BNF. Therefore I would love to see advice on how to search for info in the BNF since Y5 Medical students are not able to know specific indications and doses. All other info provided here is very useful but strategic advice is not provided
For the fluids question, initial potassium replacement should not involve glucose. This is because glucose may cause further decrease in the plasma-potassium concentration
For the first question are oral anticoagulants, like apixaban, not acceptable?
Also at 13:46 you say 54 year old, but the question says 57
Because of the haemodynamic instability the approach in management is different.
From NICE:
"Anticoagulation treatment for PE with haemodynamic instability
1.3.12 For people with confirmed PE and haemodynamic instability, offer continuous UFH infusion and consider thrombolytic therapy (see the section on thrombolytic therapy). [2020]"
From BNF entry for apixaban:
"Apixaban should not be used as an alternative to unfractionated heparin in pulmonary embolism in patients with haemodynamic instability, or who may receive thrombolysis or pulmonary embolectomy"
@@tammy8779 Cheers Tammy, will look into that. Somehow passed the PSA anyway!
@@jordanhiggs3835 Congratulations Jordan! I've still got mine to do unfortunately >_
@@tammy8779 I am sure you'll do great! If you have a physical BNF, Appendix 1 (Page 1443 in the current version BNF) has drug interactions, usually a few easy marks to gain for questions like 'which of these drugs causes hyponatraemia'
@@jordanhiggs3835 Thanks for the tip :) Hopefully I might have a physical copy to dig up from somewhere!
CCB first line for Afro Caribbean and patients over 55 - see BNF Hypertension summary
In the exam do we get to look at NICE guideline treatment summaries?
Instead of UFH, wouldn't LMWH be a better choice for question 1, like Dalteparin?
For the third question, shouldn't the first dose of the ACE inhibitor be taken before bed due to the falls risk due to reflex hypotension? Then from the second dose onwards the medication can be taken at any time consistently that the patient wants?
On the exam potassium doses are given as percentages, not mmol.
KCl 40 mmol/L = 3 g/L = 0.3%
KCl 20 mmol/L = 6 g/L = 0.15%
The advantage is that the percent stays the same when you give amounts other than a litre.
In question 2 she says mg instead of mL.
Q3 man is 57