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Question 1

In what situation do you increase the morphine dosage someone is on?

How do you do this?

How do you calculate breakthrough dosage?

Answer 1

If someone is needing to use breakthrough 3x/day increase the daily dose

• 30-50% increase (30% in elderly)

Breakthrough = 1/6th of daily dosage

Question 2

In what situations do you use oxycodone over morphine?

What must be considered when you start a pt on opioids?

Answer 2

When renal impairment use oxycodone as majority of it is metabolised in the liver

ABC
Antiemetic - ondansetron
Breakthrough pain
Constipation relief - senna

Question 3

DD of peripheral causes of vertigo

Identifying features of all

Peripheral vertigo - more likely to come and go and not assoc. with central/cerebellar signs

Answer 3

BPPV
- otolith stone in the semicircular canals
- can come out of nowhere/triggered by head movement

• diagnosed with Dix-Hallpike (makes it worse as puts stone properly into semicircular)
• managed with Epley which puts it back in

Meninere’s disease

Vertibular neuritis/labyrnithitis
- often following URTI
- N+V !!
- lasts hrs to days

Labrythnititis comes with hearing loss and tinnitus

Rule of 3’s
- 3 days in bed
- 3 weeks off work
- 3 months off balance

Ménière’s disease (MEN get STVs)
- sensiorueal hearing loss
- tinnitus
- vertigo

Manage with tinnitus therapy and hearing aids/grommets

Prevent with reduced salt, caffeine, alcohol and stress

Question 4

Episode of visible haematuria in older man with no other symptoms

Blood found on mid-urine diptix

Answer 4

Refer to urology - likely to be bladder cancer

Question 5

What is a mixed culture in a urine sample most likely to mean?

Answer 5

Contaminated sample