bits n bobs from formatives

Question 1

when do you prescribe lorazepam for delirium

Answer 1

if also got lewy body dementia or Parkinson’s

usually would give haloperidol as sedation in derlerium but antipsychotics are contraindicated in Parkinson’s/LB dementia

Question 2

causes of spinal cord compression

Answer 2

high energy injury
tumour
-extradural usually metastatic
-intradural (coming from the spine)

Question 3

treatment of spinal cord compression - oncological emergency

Answer 3

dexamethasone as a holding measure (15mg IV then 8mg oral bd)

surgery if fit enough and no evidence of mets

radiotherapy - main treatment

Question 4

how do you treat AF in a patient who is asymptomatic

Answer 4

don’t do it bruh just chill

if no other risk factors, chadvasc 0 and rate normal

Question 5

CKD and going for a contrast CT scan - what do you give first

Answer 5

0.9% NaCL

Question 6

what is raised by loads in rhabdomyelitis

Answer 6

CK (>10,000)

Question 7

drugs that cause hyponatraemia

Answer 7

SSRIs
Tricyclics
carbamazepine 
sodium valproate 
ACEis
PPIs
diuretics- bendroflumetazide

Question 8

investigation for cervical spine fractures

Answer 8

CT neck

Question 9

what investigations are done for endocarditis

Answer 9

blood cultures

transoesophageal echo

Question 10

indications for CT head after head injury within 1 hour of arrival to A&E

Answer 10

GCS <13
GCS<15 if 2 hours after injury 
suspected skull fracture 
post traumatic seizure
focal neurological deficit 
>1 episode of vomiting

Question 11

indications for CT head for head injury within 8 hours of arrival to A&E

Answer 11

none of the factors for CT within 1 hour but..

on anticoagulation 
>65
hx of bleeding or clotting disorder 
dangerous mechanism of injury 
>30mins retrograde amnesia of events before the injury

Question 12

which bone disorder has:

low vit D, low Ca, Low phosphate, normal/high ALP

Answer 12

osteomalacia

Question 13

which bone disorder has:

norm Ca, normal phosphate, norm ALP

Answer 13

osteoporosis

Question 14

which bone disorder has:

norm Ca, norm phosphate, v raised ALP

Answer 14

pagets disease

Question 15

causes of paralytic ileus

Answer 15

surgery - most common
trauma
inflammation/infection
electrolyte imbalance (hypokalaemia/hyponatraemia)

Question 16

treatment of paralytic ileus

Answer 16

nil by mouth 
NG tube 
IV fluids 
mobilisation - helps stimulate peristalsis 
Total parenteral nutrition

Question 17

when would you do an aldosterone:renin ratio

Answer 17

is suspicious of primary hyperaldosteronism (Conn’s syndrome)

aldosterone will be high in comparison to renin

usually renin causes release of aldosterone, but will be high if adrenals are producing too much aldosterone

Question 18

when would you do a albumin:creatinine ratio vs a protein:creatinine ratio

Answer 18

albumin creatinine ration when looking for microalbuminaemia as the cause of protein in urine (usually due to diabetic retinopathy)

protein:creatinine ration when you suspect a non-albumin cause of the protein in the urine

Question 19

secondary prevention of a non-cardioembolic ischaemic stroke

Answer 19

anti platelet - clopidogrel 75mg (give lansoprazole as well for gastro protection in patients at risk of ulcers)

antihypertensive - ACEi, thiazide or CCB

statin

• simvastatin 40mg if low atherosclerotic burden
• atorvastatin 80mg if high atherosclerotic border

Question 20

which antibiotics is contraindicated with statin therapy

Answer 20

clarithromycin

Question 21

secondary prevention of a cardioembolic stroke in AF

Answer 21

anticoagulant
antihypertensive
statin

Question 22

when would you give prednisolone for gout

Answer 22

if patient cant tolerate NSAIDs - eg. in CKD

Question 23

which brain lobe is most likely to be affected in early Alzheimers

Answer 23

temporal

- loss of semantic memory

Question 24

treatment for tricyclic overdose with prolonged QRS

Answer 24

give IV sodium bicarbonate

Question 25

what pain relief should be used for patients post-bowel surgery

Answer 25

epidural

good in patients with resp problems as opiates can make that worse?

Question 26

which drug can cause pulmonary fibrosis

Answer 26

amioderone

classically pulmonary fibrosis without finger clubbing

Question 27

septic + hypotensive despite fluid irescusitiation

Answer 27

give IV adrenaline