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19/07/2026



Patients with confirmed superficial vein thrombosis should be treated with anti-embolism stockings and prophylactic-dose low-molecular-weight heparin (LMWH) for 30 days or fondaparinux for 45 days.

If LMWH is contraindicated, an NSAID can be given for 8–12 days, as it reduces the risk of thrombus extension.

19/07/2026



To diagnose iron deficiency, the following tests are useful:

1. Percentage of hypochromic red cells (%HRC): The sample should be analysed within 6 hours. A value greater than 6% indicates iron deficiency.

2. Reticulocyte haemoglobin content (CHr): A value less than 29 pg is diagnostic of iron deficiency.

3. Transferrin saturation (TSAT) and ferritin: A transferrin saturation less than 20% together with a ferritin level below 100 micrograms/L is consistent with iron deficiency.

19/07/2026



Oral iron is used in patients who are not receiving erythropoietin therapy and are not on haemodialysis.

If anaemia does not improve within 3 months of oral iron treatment, switch to intravenous iron.

Patients receiving erythropoietin therapy or undergoing haemodialysis should receive intravenous iron rather than oral iron.

19/07/2026



If a patient develops significant upper gastrointestinal side effects while taking alendronate, switch to risedronate or etidronate before considering denosumab.

19/07/2026



Refractory status epilepticus is defined as failure to respond to a benzodiazepine and one appropriate second-line antiseizure medication.

The first-line treatment for status epilepticus is a benzodiazepine. In the prehospital setting, re**al diazepam or buccal midazolam is commonly used.

In the hospital, intravenous lorazepam is generally the drug of choice and may be repeated once after 5–10 minutes if seizures continue.

If seizures persist, a second-line antiseizure medication should be given, such as levetiracetam, phenytoin, or sodium valproate. Levetiracetam is generally preferred.

If seizures continue despite these treatments, the patient has refractory status epilepticus. The next step is admission to the intensive care unit (ICU), induction of general anaesthesia, and continuous EEG monitoring.

15/07/2026



Hyperemesis gravidarum may be associated with thyrotoxic thyroid function tests (TFTs) due to hCG stimulation of thyroid receptor cells.
This condition is transient and usually resolves by 20 weeks of gestation.
It is self-limiting and does not require treatment with antithyroid drugs.
It only requires a wait-and-watch approach. Treat the hyperemesis gravidarum only.

14/07/2026



In a pregnant woman with suspected pulmonary embolism first perform a chest X-ray and compression Doppler ultrasound of the legs.
If the Doppler ultrasound shows DVT start treatment immediately. You do not need any further imaging because DVT and PE are treated the same way.
If the chest X-ray is normal and the Doppler ultrasound is negative discuss the options with the patient and obtain informed consent before performing either a V/Q scan or CT pulmonary angiography (CTPA).
A V/Q scan exposes the fetus to slightly more radiation and is associated with a slightly increased risk of childhood cancer whereas CTPA exposes the mother's breasts to more radiation, resulting in a slightly increased lifetime risk of breast cancer.

14/07/2026



In a patient with acute symptomatic hyponatraemia caused by SIADH treat with 3% hypertonic sodium chloride.
The initial goal is to increase the serum sodium by 4–6 mmol/L in the first 24 hours.

Fluid restriction (800 mL/day) is used for chronic asymptomatic hyponatraemia not for acute symptomatic hyponatraemia.

13/07/2026



Tryptase is the most specific marker of anaphylaxis.

It rises immediately after the onset of anaphylaxis reaches its maximum level at about 30 minutes and peaks within 2 hours.

It usually returns to normal within 6 hours.

if you measure the tryptase level 12–24 hours after anaphylaxis it may be normal.

13/07/2026



In a symptomatic COPD patient who is taking only salbutamol and has no steroid-responsive features, such as eosinophilia, a history of asthma, or significant bronchodilator reversibility on spirometry the next step is to prescribe a combination of a LAMA and a LABA, not a LAMA or LABA alone.

If the patient has steroid-responsive features add an inhaled corticosteroid (ICS), giving a combination of LAMA or LABA + ICS or triple therapy of LAMA+LABA+ICS.

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