3

Question 1

Epigastric pain - causative med from atenolol, baclofen, olanzapine, prednisolone?

Answer 1

prednisolone - decreases gastric secretions increasing risk of gastric ulceration

Question 2

Discoloured patches on skin - bilateral and simultaneous. No change in texture. Affect areas around mouth, eyes, fingers, wrists, armpits, groin

Answer 2

Vitiligo

Question 3

Discoloured patches on skin - not symmetrical or simultaneous, slightly scaly or flaky. Affect chest, tummy, back and arms

Answer 3

Pityriasis versicolor

Question 4

S/E of propranolol

Answer 4

fatigue

Question 5

Trimethoprim and MTX interaction

Answer 5

both folate antaganists - C/I to take both as may lead to bone marrow suppresion and neutropenic sepsis``

Question 6

Why can carbimazole sometimes cause a sore throat?

Answer 6

bone marrow suppression -> agranulocytosis

Question 7

How would you test for Cushing’s syndrome?

Answer 7

Large amounts of cortisol produced by adrenal glands

Overnight dexamethasone suppression test - take a dose and see how it affects the level of cortisol in the blood

Question 8

16 month old - barking cough, cold symptoms, over 48 hours symptoms worsen, rasping noises on inhalation and overall strenuous breathing. What could be the diagnosis and treatment?

Answer 8

Croup, single dose of dexamethasone

Question 9

When can clozapine be initiated?

Answer 9

When 2 antipsychotics have been tried and unsuccessful

Question 10

Nature of tamoxifen interaction with warfarin

Answer 10

Tamoxifen increases efficacy of warfarin therefore increase INR

Question 11

Risk of faecal impaction associated with which laxative (in opioid induced constipation)

Answer 11

isphaghula husk MHRA opioid learning module

Question 12

COMT parkinsons meds - which is associated with fatal liver injury?

Answer 12

Tolcapone - usually women and in first 6 months. Test liver function 2 weekly for first year then 4 weekly for 6 months then 8 weekly thereafter

Question 13

Prophylactic enoxaparin and stroke

Answer 13

contraindicated

Question 14

Do statins affect risk of extravasation?

Answer 14

no

Question 15

Levothyroxine risk of side effects

Answer 15

narrow therapeutic drug so increased risk of toxicity - tremor, tachycardia, weight loss and anxiety

Question 16

Fun facts athlete’s foot

Answer 16

Cure not achievable in 20-40% of patients

Relapse in 20-25%

Question 17

Treatment for severe flare up of crohns

Answer 17

IV steroids and IV fluids

Antibiotics only in inflammatory markers and fever.

IV dextrose not 1st line not appropriate to give over 24 hour period

IV hydrocortisone 100mg qds

Question 18

treatment of rickets vitamin

Answer 18

D

Question 19

s/e amiloride (electrolyte imbalance)

Answer 19

hyperkalaemia

Question 20

type of insulin - lispro, glulisine?

Answer 20

rapid (immediately before meals)

Question 21

type of insulin - aspart?

Answer 21

rapid (immediately before meals)

Question 22

type of insulin - glargine, degludec?

Answer 22

long 1x daily

Question 23

type of insulin - detemir?

Answer 23

long 1x or 2x daily

Question 24

human, bovine porcine - insulin type?

Answer 24

soluble

Question 25

isophane

Answer 25

intermediate - similar to endogenous basal insulin (can be mixed with short acting (up to 15-50% short acting) shortly before a meal)
intermediate alone may be once a day or more

Question 26

the most appropriate form of insulin for use in diabetic emergencies e.g. Diabetic ketoacidosis and peri-operatively.

Answer 26

Soluble insulin administered intravenously

Question 27

soluble SC insulin

• time to action
• peak action
• duration of action

Answer 27

time to action 30-60 mins
peak 1-4 hours
duration 9 hours

Question 28

rapid acting insulin

• time to action
• duration of action

Answer 28

• 15 mins

- 2-5 hours

Question 29

Intermediate insulin

• time to action
• peak
• duration of action

Answer 29

• 1–2 hours
• 3–12 hours
• 11–24 hours.