Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

301 > Clinical > Flashcards

Clinical Flashcards

1
Q

Common conditions affecting GIT?

A

Oral cavity conditions
Dyspepsia
Gastritis
Malabsorption
Pancreatitis
Hepatitis
Biliary colic
IBD
IBS
Diverticulitis
Appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Common symptoms of GI conditions?

A

Abdominal pain and discomfort
Nausea
Vomiting
Diarrhoea
Constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Questions to ask for abdominal pain?

A

Site
Onset
Character
Radiation
Associated symptoms
Timing
Exacerbating factors/ Relieving factors
Severity
SOCRATES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What could sudden onset abdominal pain suggest?

A

Peritonitis
Appendicitis
Ectopic pregnancy
Renal or biliary colic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What could cramp-like abdominal pain suggest?

A

Diverticulitis
IBS
Gastroenteritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What could colic-like abdominal pain suggest?

A

Appendicitis
Biliary or renal colic
Intestinal obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What could gnawing abdominal pain suggest?

A

Pancreatitis
Pancreatic cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What could abdominal pain that radiates to the jaw, face or arm suggest?

A

Cardiovascular in origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What could abdominal pain that radiates from the centre to the RLQ suggest?

A

Appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What could abdominal pain radiating to the back suggest?

A

Peptic ulcer
Pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Symptoms associated with abdominal pain that could suggest a more serious pathology?

A

Nausea
Vomiting
Weight loss
Melaena
Altered bowel habits
Haematemesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Symptoms of acute cholecystitis?

A

Colic-like pain
Severe in nature
Lasting 30 minutes to 8 hours
Nausea, vomiting, fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is IBS classes as?

A

A functional bowel disorder (absence of abnormality)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What percentage of adults are affected by IBS?

A

10-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Does IBS affect men or women more?

A

Twice as many women affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Normal age of incidence for patients with IBS?

A

20-30 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What quadrant does IBS affect?

A

LLQ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

IBS symptoms?

A

Abdominal pain and discomfort (relief of defecation)
Altered bowel habits
Diarrhoea
Constipation
Bloating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How long must symptoms persist before diagnosing IBS?

A

6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Causes of IBS?

A

No known cause
Multifactorial
Motility dysfunction
Diet
Genetics
Psychological factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Red flag symptoms in IBS?

A

Blood in stools
Fever
Nausea
Vomiting
Severe pain
Aged under 16
Aged over 45
Steatorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

IBS diet management?

A

Identify and avoid trigger food
Low FODMAP diet (as absorbed poorly by small intestine so can cause symptoms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does FODMAP stand for?

A

fermentable oligosaccharides, disaccharides, monosaccharides and polyols,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lifestyle management for IBS?

A

Reduce stress and psychological distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Drug management in IBS?

A

Antispasmodics
Loperamide
Laxatives
Low dose tricyclic or SSRI (second line) for refractory abdominal pain
Herbal medicine and probiotics (lacking evidence)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Diarrhoea definition?

A

Passage of three or more lose or liquid stools per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Types of diarrhoea?

A

Acute
Persistent
Chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Time frame for acute diarrhoea?

A

< 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Time frame for persistent diarrhoea?

A

> 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Time frame for chronic diarrhoea?

A

> 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Causes of diarrhoea?

A

Viruses
Bacteria
Parasites
Drug-induced
IBS
IBD
Coeliac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Drugs that can commonly cause diarrhoea?

A

Laxatives
Magnesium containing antacids
Metformin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

RED flag symptoms in diarrhoea?

A

Change in long term bowel habits aged over 50
Following recent travel
Longer than 2-3 days in children or elderly
Blood or mucous present
Severe abdominal pain
Steatorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Diarrhoea management?

A

Oral rehydration solution
Rice based ORS
Loperamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Loperamide dose for acute diarrhoea?

A

Initially 4 mg, followed by 2 mg for up to 5 days, dose to be taken after each loose stool; usual dose 6–8 mg daily; maximum 16 mg per day.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Loperamide dose for acute diarrhoea?

A

Initially 4 mg, followed by 2 mg for up to 5 days, dose to be taken after each loose stool; usual dose 6–8 mg daily; maximum 16 mg per day.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What does GORD stand for?

A

Gastro-oesophageal reflux disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is GORD?

A

Condition affecting the GI tract whereby the acidic contents of the stomach are able to flow back into the oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

When does GOR become GORD?

A

When symptoms occurs twice or more a week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is dyspepsia?

A

Pain or discomfort, including upper abdominal pain, heartburn, reflux, bloating, early satiety, fullness or nausea centred in the upper abdomen/GI tract.
Symptoms typically present for four weeks or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Pathophysiology of GORD?

A

Reflux occurs when there is loss of tone of the lower oesophageal sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Does genetics impact GORD?

A

Higher risk is immediate family member suffers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Can age impact GORD?

A

More likely with increasing age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Risk factors for GORD?

A

Family history
Age
Pregnancy
Obesity
Ascites
Stress
Smoking
Medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Dietary triggers of GORD?

A

Spice
Fats
Chocolate
Mint
Caffeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

When are gastric contents more likely to reflux?

A

Gastric volume is increased
After meals if gastric emptying is impaired
Gastric contents are near the junction
Posture
Gastric pressure is increased
Tight clothes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Medications linked with GORD?

A

NSAIDs
CCBs
Nitrates
Antibiotics
Bisphosphonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is a hiatus hernia?

A

Structural abnormality where the superior part of the stomach protrudes slightly above the diaphragm through the diaphragmatic hiatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What causes hiatus hernia?

A

Most often due to an abnormal relaxation or weakening of the sphincter
Caused by physical exertions which increase abdominal pressure e.g. coughing, vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Risk factors for hiatus hernia?

A

Obesity
Pregnancy
Increasing age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Why can reflux occur with hiatus hernia?

A

The diaphragm aids in maintaining the anti-reflux barrier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Common symptoms of GORD?

A

Heartburn
Regurgitation
Waterbrash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is heartburn?

A

A feeling of burning rising up from the stomach or lower chest towards the neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is waterbrash?

A

Acidification of the oesophagus causes sudden stimulation of saliva. Mouth fills with saliva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Atypical symptoms of GORD?

A

Chest pain
Cough
Asthma
Throat changes
Voice changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

GORD complications?

A

Reflux oesophagitis
Stricture
Barrett’s oesophagus
Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is reflux oesophagitis?

A

Where the mucosal defences and unable to counteract the damage caused by acid, pepsin, and bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Types of reflux oesophagitis?

A

Non -erosive
Erosive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What happens to the oesophagus in Barrett’s oesophagus?

A

Distal squamous epithelium converted to columnar epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Prevalence of GORD in babies?

A

~40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

When may medical treatment be required in a baby with GORD?

A

Distressed behaviour
Gagging
Choking
Faltering growth
Chronic cough
Pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

GORD treatment in breast-fed baby?

A

Feeding assessment
Alginate trial- gaviscon infant for 1-2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Maximum dose of gaviscon infant?

A

6 if < 4.5kg
12 if > 4.5kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

GORD treatment in bottle-fed baby?

A

More frequent but smaller feeds
Thickened formula e.g. Carobel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What percentage of the population experience dyspepsia at least once a week?

A

15-25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Red flags in dyspepsia?

A

GI bleeding
Difficulty swallowing
Weight loss
Abdominal swelling
Vomiting
>50 with new onset
<18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Investigations involved with GORD?

A

Endoscopy
Biopsies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Aims of GORD treatment?

A

Manage symptoms
Treat underlying causes
Do not exacerbate co-morbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Lifestyle changes for dyspepsia?

A

Healthy eating
Weight reduction
Smoking cessation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

General management principles of GORD?

A

Lifestyle changes
Avoid food triggers
Raise the bed head at night
Avoid large meals before bed
Withdrawal of trigger medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Pharmacological options for dyspepsia?

A

Antacids
H2 receptor antagonist
PPIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

How do antacids work?

A

Neutralise HCl secreted by gastric parietal cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Pros and cons of liquid antacids?

A

More effective but less convenient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Examples of antacids?

A

Aluminium hydroxide
Calcium carbonate
Magnesium salts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Which antacid salts can cause diarrhoea?

A

Magnesium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Which antacid salts can cause constipation?

A

Aluminium
Calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Antacids with high sodium content should be avoided in which conditions?

A

Heart failure
Renal failure
Cirrhosis
Oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Which antacid salt can accumulate in renal disease?

A

Aluminium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Antacid drug interactions?

A

Take two hours before or after other medications
Phenytoin, quinolones, doxycycline, iron, levothyroxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Why do antacids have so many interactions?

A

Decrease absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

How do alginates works?

A

Rafting agents
Increase viscosity of stomach contents and protect oesophageal mucosa from acid contents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Examples of H2 antagonists?

A

Famotidine
Cimetidine
Nizatidine
Ranitidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

How do H2 antagonists work?

A

Competitively block H2 receptors on the parietal cell reducing gastric acid secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Which H2 antagonist is associated with the most side effects?

A

Cimetidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Cimetidine side effects?

A

CNS- slurred speech, confusion
Endocrine- gynaecomastia, galactorrhea
Blood dyscrasias
Liver toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Cimetidine drug interactions?

A

Phenytoin
Carbamazepine
Theophylline
All levels increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Why was ranitidine withdrawn from the UK market?

A

Link to increase in NDMA, a probable carcinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Examples of PPIs?

A

Esomeprazole
Lansoprazole
Omeprazole
Rabeprazole
Pantoprazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

How do PPIs work?

A

Irreversibly inactivate the hydrogen/potassium ATPase enzyme system thus suppressing both stimulated and basal acid secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Drugs that can cause or exacerbate GORD/dyspepsia?

A

alpha-blockers
anticholinergics
benzodiazepines
beta-blockers
bisphosphonates
calcium-channel blockers, corticosteroids
NSAIDs
nitrates
theophyllines
tricyclic antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is misoprostol licensed for? (Gastro)

A

Benign gastric ulcer
Benign duodenal ulcer
NSAID-induced peptic ulcer
Prophylaxis of NSAID-induced peptic ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Usual misoprostol treatment dose?

A

400 micrograms twice daily, alternatively 200 micrograms 4 times a day continued for at least 4 weeks or may be continued for up to 8 weeks if required, dose to be taken with breakfast (or main meals) and at bedtime.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Usual misoprostol prophylactic dose?

A

200 micrograms 2–4 times a day.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Cautions for misoprostol? (Gastro)

A

Conditions where hypotension might precipitate severe complications (e.g. cerebrovascular disease, cardiovascular disease); conditions which predispose to diarrhoea (e.g. inflammatory bowel disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Possible severe side effect of misoprostol?

A

Diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

How does misoprostol work for gastric ulcers?

A

Misoprostol is a synthetic prostaglandin analogue that has antisecretory and protective properties, promoting healing of gastric and duodenal ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

How does sucralfate work?

A

Sucralfate is a complex of aluminium hydroxide and sulfated sucrose which forms a barrier to protect the mucosa from acid, pepsin and bile attack in gastric and duodenal ulcers.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Licensed uses of sucralfate?

A

Benign gastric ulceration
Benign duodenal ulceration
Chronic gastritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Cautions of sucralfate?

A

Following reports of bezoar formation associated with sucralfate, caution is advised in seriously ill patients, especially those receiving concomitant enteral feeds or those with predisposing conditions such as delayed gastric emptying.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

When should sucralfate be taken?

A

1 hour before meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Maximum daily dose of sucralfate?

A

8g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Functional vs uninvestigted dyspepsia?

A

Functional is where an endoscopy has been performed but nothing found to explain symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Initial management of uninvestigated dyspepsia?

A

PPI for four weeks
Test for H.pylori
(If high risk for H.pylori then test first or in parallel with PPI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Initial management of functional dyspepsia?

A

Test for H.pylori
If negative then PPI or H2 antagonist for four week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Follow up management of dyspepsia?

A

Assess for new alarm symptoms
Consider alternative diagnosis
Check adherence to both drugs and lifestyle measures
PPI or H2 can be continued at lowest dose to control symptoms (PRN can be considered)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

How often should patients with dyspepsia be reviewed?

A

Annually
Encourage a step down approach of possible
Return to self-treatment with alginates or antacids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

When to refer a dyspepsia patient to specialist care?

A

Unexplained or unresponsive Gastro oesophageal symptoms or if H.pylori not responsive to second line treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Definition of a peptic ulcer?

A

Disruption of the mucosal integrity of the stomach and/or duodenum leading to local defect or excavation due to active inflammation.
>5mm in size that reach the sub-mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What causes a peptic ulcer to form?

A

An imbalance between the protective and destructive (gastric acid, Pepsis) factors present in the stomach and duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

The three major protective factors in the Gastro-duodenal defence mechanism?

A

Mucous/bicarbonate layer
Surface epithelial cells
Prostaglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What produces the mucous/bicarbonate layer in the gastro-duodenal system?

A

Epithelial cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What does the mucous/bicarbonate layer in the gastro-duodenal system contain?

A

Water, lipids and glycoproteins (mucin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Purpose of the mucous/bicarbonate layer in the gastro-duodenal system?

A

Sets up a pH gradient to prevent diffusion of ions and molecules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

pH of the mucous/bicarbonate layer in the gastro-duodenal system?

A

1-2 at luminal surface
6-7 on epithelial surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What do epithelial cells do to protect in the gastro-duodenal system?

A

Produce mucous
Have tight junctions to form a protective seal
Cells replaced quickly and undergoing constant turnover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What do prostaglandins do to protect the gastro-duodenal system?

A

High levels in the gastric mucosa
Regulate release of mucosal bicarbonate and mucous
Inhibit parietal cell secretion and maintain blood flow and epithelial cell repair and replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What type of peptic ulcer is most common?

A

Duodenal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What age are gastric ulcers most likely to occur?

A

60s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Where are 90% of duodenal ulcers located?

A

Within 3cm of the pylorus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Which type of peptic ulcer is most likely to represent a malignancy?

A

Gastric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Pain described in both types of peptic ulcer?

A

Epigastic described as burning or gnawing
Discomfort described as an ill defined aching or hunger pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Typical pain pattern for a duodenal ulcer?

A

90 minutes to 3 hours after food
2/3 patients report pain awakening them at night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What frequency relieves duodenal ulcer pain?

A

Antacids
Food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Food can worsen pain causes by what kind of ulcer?

A

Gastric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Nausea and weight loss is most commonly associated with which type of ulcer?

A

Gastric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Main two causes of peptic ulcers?

A

H.pylori
NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Other trigger factors for peptic ulcers?

A

Mental stress
Smoking
Corticosteroids
Zollinger-Ellison syndrome
Blood group O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

How does H.pylori cause ulcers?

A

Bacteria produces urease which allows bacteria to survive in acidic environment
Produces surface factors that are chemotactic for immune cells
Makes proteases and lipases that break down mucous gel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

How can NSAIDs cause gastric ulcers?

A

Prostaglandins and important in maintaining Gastro-duodenal integrity
Therefore when synthesis disrupted ulcers can form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What is Zollinger-Ellison syndrome?

A

tumors in the first part of the small intestine, the pancreas, or both. These tumors, called gastrinomas, release the hormone gastrin. This causes the stomach to release too much acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Zollinger-Ellison syndrome treatment?

A

High dose PPIs
Surgery
Chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Peptic ulcer complications?

A

Gastric outlet obstruction
Intestinal perforation and haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Patients at high risk with an NDSAID?

A

> 65 years
High doses
Other medications that increase pelvic ulcer risk
Serious co-morbidities
Heavy smokers
Excess alcohol
Previous ADR to NSAIDs
Prolonged need for NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

How to test for peptic ulcers?

A

Endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Do PPIs need to be stopped before endoscopy for peptic ulcer?

A

Yes- two weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Do H2 antagonists need to be stopped before endoscopy for peptic ulcer?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Do antibiotics need to be stopped before endoscopy for peptic ulcer?

A

Yes- two weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Gold-standard tests for H.pylori?

A

Urea breath test
Stool antigen
Endoscopy with biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Aims of peptic ulcer treatment?

A

Promote ulcer healing
Manage symptoms
Treat H.pylori if appropriate
Reduce risk of complications and recurrence
Not exacerbate co-morbidities

140
Q

Why should caffeine be avoided for peptic ulcer patients?

A

It is a gastric acid stimulant

141
Q

Non-pharmacological management of peptic ulcers?

A

Healthy eating
Weight loss
Avoid trigger foods
Smaller meals
Evening meal 3-4 hours before bed
Raise bed head
Avoid smoking
Avoid alcohol
Avoid ulcerogenic drinks
Avoid caffeine
Stress management

142
Q

When would an urgent endoscopy be needed for dyspepsia?

A

Dysphasia
Significant GI bleeding
Aged >55 with significant weight loss

143
Q

Initial management of peptic ulcer?

A

Stop ulcer inducing medication if possible
Antacids can be used short term
Test for H.pylori

144
Q

Initial management of a peptic ulcer when H.pylori positive without a history of NSAID use?

A

H.pylori eradication

145
Q

Initial management of a peptic ulcer with a history of NSAID use?

A

PPI for eight weeks followed by H.pylori eradication of positive

146
Q

Initial management of a peptic ulcer when H.pylori negative without a history of NSAID use?

A

PPI or H2 antagonist for 4-8 weeks

147
Q

Follow up management of peptic ulcer if H.pylori positive?

A

Depending on size
Review 6-8 weeks after eradication and re-test
Repeat endoscopy to confirm healing

148
Q

What to do if ulcer healed and NSAIDs still required?

A

Review NSAID every six months
Consider alternative analgesic
Prescribe Gastro protection

149
Q

What happens if symptoms recur after ulcer treatment?

A

Low dose PPI may be used

150
Q

H.pylori eradication method?

A

Triple therapy for 1 week
1 PPI
2 antibiotics
If ulcer large or complicated the continue for another 3 weeks

151
Q

First-line H.pylori eradication?

A

Lansoprazole 30mg BD OR omeprazole 20-40mg BD
Amoxicillin 1g BD
Clarithromycin 500mg BD OR metronidazole 400mg BD

152
Q

First-line H.pylori eradication of penicillin allergic?

A

Lansoprazole 30mg BD OR omeprazole 20-40mg BD
Clarithromycin 250mg BD
Metronidazole 400mg BD

153
Q

Second-line treatment for H.pylori eradication?

A

Lansoprazole 30mg BD OR omeprazole 20-40mg BD
Amoxicillin 1g BD
Clarithromycin 500mg BD OR metronidazole 400mg BD (whichever not used first line)

154
Q

Second-line H.pylori eradication if penicillin allergic?

A

Lansoprazole 30mg BD OR omeprazole 20-40mg BD
Metronidazole 400mg BD
Levofloxacin 250mg BD

155
Q

When should a PPI be routinely prescribed with an NSAID?

A

Osteoarthritis
Rheumatoid arthritis
Anyone >45 with chronic lower back pain

156
Q

When should a PPI be considered with an NSAID?

A

> 65 years
Long term use
Other medications- antiplatelets, SSRIs, corticosteroids, nicorandil

157
Q

Issues with long term PPIs?

A

C.diff
Bone fractures

158
Q

What kind of condition is coeliac?

A

Autoimmune

159
Q

Coeliac prevalence?

A

~1%

160
Q

Symptoms of coeliac disease?

A

Bloating
Diarrhoea
Flatulence
Constipation
Tiredness
Headaches
Sudden weight loss
Hair loss
Anaemia
Osteoporosis
Rash
neurological disorder

161
Q

Rash seen in coeliacs?

A

Dermatitis herpetiformis

162
Q

What is this a symptoms of?

A

Coeliac disease

163
Q

Most common presentation during coeliac diagnosis?

A

Diarrhoea

164
Q

Two common proteins in gluten responsible for coeliac disease?

A

Gliadin
Glutenin

165
Q

How much gluten can a coeliac patient tolerate?

A

20 parts per million

166
Q

Coeliac disease is what immune cell mediated?

A

T-cell (CD4+)

167
Q

Antibodies involved in coeliac disease?

A

IgA
IgG

168
Q

What genes are involved in coeliac disease?

A

HLA-DQ2 (90%)
HLA-DQ8 (10%)

169
Q

How are MHC II molecules involved in coeliac disease?

A

The specific genes found for patients with these MHC II molecules make them bind to charged particles.
Gluten is not a charged particle but can be deaminated by transglutaminase enzymes
They bind to gluten and recognise it as foreign

170
Q

How to diagnose coeliac disease?

A

Serum analysis for anti-gliadin/transglutamidase antibodies
ELISA
Intestine biopsy
HLA typing

171
Q

What is a common deficiency in coeliac patients?

A

Calcium

172
Q

Symptoms of vomiting?

A

Nausea
Retching
Emesis

173
Q

Possible causes of nausea and vomiting?

A

Pregnancy
Motion sickness
Gastroenteritis
Appendicitis
Cholecystitis
Cholelithiasis
Peptic ulcers
Migraine

174
Q

Nausea affects what percentage of pregnant women?

A

70%

175
Q

Vomiting affects what percentage of pregnant women?

A

60%

176
Q

What trimester is nausea and vomiting most common?

A

First

177
Q

What causes nausea and vomiting in pregnancy?

A

A surge in hormone levels

178
Q

Self-care measures for nausea and vomiting?

A

Rest
Avoid triggers
Eat plain biscuits or crackers
Eat bland small meals which are low in carbohydrates and fats and high in protein
Cold meals may be better tolerated
Drink little and often
Ginger
Acupressure

179
Q

First line drug treatments for nausea and vomiting in pregnancy?

A

Cyclizine
Promethazine
Prochlorperazine
Chlorpromazine
Doxylamine/pyridoxine (Xonvea)

180
Q

What is the only licensed drug for nausea and vomiting in pregnancy?

A

Doxylamine/pyridoxine (Xonvea)

181
Q

Second line antiemetics in pregnancy?

A

Metoclopramide
Ondansetron
Domperidone

182
Q

Why can nausea and vomiting due to pregnancy not be managed OTC?

A

Lack of licensing
Safety concerns

183
Q

Symptoms of motion sickness?

A

Nausea
Pallor
Abdominal discomfort
Vomiting

184
Q

What is habituation in regards to motion sickness?

A

Symptoms normally improve after a prolonged exposure to the motion

185
Q

Who is motion sickness most common in?

A

Children

186
Q

What causes motion sickness?

A

Inability of brain to process conflicting information from sensory nerve terminals regarding movement and position

187
Q

Number of migraine sufferers in the UK?

A

5 million

188
Q

Most common age for migraines?

A

Adolescence

189
Q

Migraine symptoms?

A

Headache
Nausea and vomiting
Visual disturbance

190
Q

OTC medications for migraine-induced nausea and vomiting?

A

Buccal prochlorperazine
Buclizine in migralieve

191
Q

What can nausea and vomiting in a baby under 1 month be a sign of?

A

Hirschsprung’s disease

192
Q

What is Hirschsprung’s disease?

A

the nerves that control this movement are missing from a section at the end of the bowel, which means poo can build up and form a blockage

193
Q

Conditions to eliminate in infants presenting with nausea and vomiting?

A

Hirschsprung’s disease
Feeding problems

194
Q

Conditions to exclude when presenting with nausea and vomiting?

A

Gastritis
Migraines
Medication induced
Excess alcohol
Pregnancy

195
Q

Medications that can cause nausea and vomiting?

A

Cytotoxics
NSAIDs
Opiates
Iron
Antibiotics
SSRIs
Theophylline
Digoxin

196
Q

Red flag symptoms for nausea and vomiting?

A

Suspected pregnancy
Vomiting for more than 24 hours in a child under one year
Children who fail to respond to OTC treatment
Unexplained nausea and vomiting in any age group
Moderate to severe abdominal pain
Haematemesis

197
Q

Drugs licensed for motion sickness?

A

Cyclizine
Cinnarizine
Promethazine
Hyoscine
Scopolamine

198
Q

Why was Domperidone removed from OTC sale and when?

A

License revoked in 2014 due to risk of serious cardiac side effects

199
Q

How does prochlorperazine work for nausea and vomiting?

A

Works by blocking dopamine receptors located in the chemoreceptor trigger zones

200
Q

What is OTC prochlorperazine licensed for?

A

Nausea and vomiting associated with migraines
18 years +

201
Q

Buccal prochlorperazine dosing?

A

3-6mg BD

202
Q

Side effects of Buccal prochlorperazine?

A

Drowsiness
Dizziness
Dry mouth
Insomnia
Agitation
Skin reactions

203
Q

Buccal prochlorperazine interactions?

A

Crossed BBB so potentiates side effects of CNS depressants and alcohol

204
Q

Buccal administration?

A

Place tablet between upper lip and gum
Allow to dissolve gently. Will soften and form a gel like substance in 1-2 hours
Takes between 3-5 hours to fully dissolve
Do not chew, crush or shallow

205
Q

Side effects of antihistamine motion sickness treatment?

A

Dry mouth
Constipation
Sedation

206
Q

Antihistamine motion sickness treatment interactions?

A

Alcohol
Opioids
Hypnotics
Antidepressants

207
Q

Cautions for antihistamine motion sickness treatment?

A

Angle-closure glaucoma
Enlarged prostate

208
Q

What age is Cyclizine licensed for in motion sickness?

A

> 6 years

209
Q

What age is cinnarizine licensed for in motion sickness?

A

> 5 years

210
Q

What age is promethazine licensed for in motion sickness?

A

> 5 years

211
Q

What length journeys are antihistamine based motion sickness treatments recommended for?

A

Longer journeys

212
Q

Stugeron dosing for those aged over 12 years?

A

2 tablets two hours before you travel and 1 tablet every eight hours during your journey.

213
Q

Stugeron dosing for ages 5-12 years?

A

1 tablet two hours before you travel and half a tablet every 8 hours during your journey.

214
Q

Avomine dose for adults?

A

2 tablets

215
Q

Avomine dose for children over 10?

A

1 tablet

216
Q

Avomine dose for children aged 5-10?

A

Half a tablet

217
Q

How does Hyoscine work to prevent motion sickness?

A

Affects your inner ear and brain to control vomiting and relaxes muscles in the walls of the stomach

218
Q

Side effects of Hyoscine hydro bromide?

A

Dry mouth
Sedation
Other anticholinergic side effects

219
Q

Hyoscine hydrobromide interactions ?

A

TCAs
Neuroleptics
Antimuscarinics

220
Q

Cautions for Hyoscine hydrobromide?

A

Angle-closure glaucoma
Enlarged prostate

221
Q

Age Joyrides are licensed for?

A

> 3 years

222
Q

Age kwells kids are licensed for?

A

> 4 years

223
Q

Age kwells are licensed for?

A

> 10 years

224
Q

Age scopoderm is licensed for?

A

> 10 years

225
Q

Recommended travel durations for Hyoscine?

A

Less than 4 hours excluding scopoderm

226
Q

Kwells kids dose for ages 4-10 years?

A

½-1 tablet every 6 hours if required. Do not take more than 1½-3 tablets in 24 hours.

227
Q

Kwells kids dose for children over 10 years?

A

1-2 tablets every 6 hours if required. Do not take more than 3-6 tablets in 24 hours.

228
Q

When to take kwells?

A

Tablets to be taken up to 30 minutes before the start of the journey to prevent travel sickness, or at the onset of nausea.

229
Q

Kwells dose for adults?

A

1 tablet every 6 hours if required. Do not take more than 3 tablets in 24 hours.

230
Q

Joy rides doses for children?

A

20 minutes before journey.
7 - 12 years: 1 -2 tablets.
4 - 7 years: 1 tablet. Maximum 2 tablets in 24 hours.
3 – 4 years: half a tablet. Maximum 1 tablet in 24 hours.

231
Q

Joy rides dose for ages 13 years and over?

A

2 tablets 20 minutes before start of the journey. Maximum 4 tablets in 24 hours.

232
Q

How long do scopoderm patches work for?

A

72 hours

233
Q

How long before a journey should a scopoderm patch be applied?

A

5-6 hours

234
Q

Where should a scopoderm patch be placed?

A

clean, dry, hairless area of skin behind the ear, taking care to avoid any cuts or irritation

235
Q

Normal bowel habit?

A

Three times a day to three times a week

236
Q

Signs of bowel obstruction?

A

Constipation
Colicky abdominal pain
Abdominal distension
Vomiting

237
Q

Lifestyle advice for constipation?

A

Increase fibre
Exercise
Drink more
Reduce alcohol

238
Q

What can overuse of stimulant laxatives cause?

A

Loss of muscular activity in the bowel wall (atonic colon)

239
Q

Drugs that can cause constipation?

A

Opioids
Antacids (aluminium)
Antimuscarinics
Phenytoin
Antidepressants
Antihistamines
Levodopa
Verapamil
Calcium supplements
Bendroflumethiazide
Iron
Laxative abuse

240
Q

When to refer for constipation?

A

Change in bowel habits that last > 2 weeks
Abdominal pain, vomiting, bloating
Weight loss
Blood in stools
Prescribed medication suspected to be the cause
Failure of OTC treatment

241
Q

What are first line laxatives?

A

Bulk forming

242
Q

How do bulk forming laxatives work?

A

Swelling in the gut to increase faecal mass and stimulate peristalsis

243
Q

How long do bulk forming laxatives take to work?

A

Can be several days

244
Q

Why is it important to increase fluid intake with bulk forming laxatives?

A

Can cause intestinal obstruction

245
Q

When are bulk forming laxatives not considered appropriate?

A

Opioid-induced constipation

246
Q

Why are bulk forming laxatives not suitable for opioid-induced constipation?

A

The problem relates to decreased motility of the gut

247
Q

How to osmotic laxatives work?

A

Maintaining the volume of fluid in the bowel

248
Q

How long do osmotic laxative take to work?

A

1-2 days

249
Q

Examples of osmotic laxatives?

A

Lactulose
Macrogol

250
Q

Side effects of lactulose?

A

Flatulence
Cramps
Abdominal discomfort

251
Q

How do glycerin suppositories work?

A

Have an osmotic and irritant effect

252
Q

How long to glycerin suppositories take to work?

A

Within 1 hour

253
Q

How do stimulant laxatives work?

A

Stimulate nerves in the colon and rectum and increasing peristalsis

254
Q

Example of stimulant laxatives?

A

Bisacodyl
Senna
Picosulfate

255
Q

Age for stimulant laxatives?

A

12 plus

256
Q

How long should stimulant laxatives be used for?

A

No longer than one week

257
Q

How long to stimulant laxatives take to work?

A

Orally 6–12 hours
Rectally 15-60 minutes

258
Q

Example of a stool softener?

A

Docusate

259
Q

How does docusate work?

A

Lowers surface tension at the oil-water interface of the faeces, enabling water and lipids to enter and soften the stool
Also has stimulant effects

260
Q

How long does docusate take to work?

A

1-2 days

261
Q

Who is constipation most common in?

A

Women
Elderly
Pregnancy

262
Q

What is chronic constipation?

A

Symptoms present for at least three months

263
Q

Example of a prokinetic laxative?

A

Prucalopride

264
Q

Constipated stools are usually which type on the Bristol stool chart?

A

1 or 2

265
Q

Conditions that can cause constipation?

A

Hypothyroidism
Depression
Parkinson’s
Angina or recent MI
Recent surgery
Haemorrhoids
Pregnancy

266
Q

Risk factors for C.diff?

A

Advanced age
Underlying morbidity
Use of PPIs
Antibiotic use

267
Q

When to refer for diarrhoea?

A

Dehydration suspected
> 1 day in under 1
> 2 days in under 3 and elderly
>3 days in older children and adult
Severe vomiting
After a course of antibiotics
Fever
Food poisoning outbreak
Travel abroad
Drug induced
Change in bowel habit
Blood or mucus in stool
Elderly or underlying condition
Weak immune system
Pregnancy

268
Q

Maximum daily dose of loperamide for adults?

A

12mg

269
Q

Maximum daily dose of loperamide for those aged 12-18 years?

A

6mg

270
Q

What is classed as chronic diarrhoea?

A

> 4 weeks

271
Q

What is classed as persistent diarrhoea?

A

> 14 days

272
Q

What is classed as acute diarrhoea?

A

<14 days

273
Q

Drugs associated with diarrhoea?

A

Laxatives
Allopurinol
Angiotensin-II blockers
Antibiotics
Chemo
Magnesium
Antacid
NSAIDs
PPIs
SSRIs

274
Q

Complications of diarrhoea?

A

Dehydration
Negative quality of life

275
Q

How long does viral diarrhoea usually last?

A

2-3 days

276
Q

How long does untreated bacterial diarrhoea usually last?

A

3-7 days

277
Q

Red flags for acute diarrhoea?

A

Blood in stool
Recent hospital treatment
Recent antibiotic use
Weight loss
Evidence of dehydration
Nocturnal symptoms

278
Q

Features of dehydration?

A

Increase heart rate
Reduced skin tugor
Dryness of mucous membranes
Delayed capillary refill time
Decreased urine output
Hypotension
Altered mental status

279
Q

How does loperamide work?

A

Acts via opioid receptors
Slows GI tract time
Increases capacity of gut

280
Q

Possible side effects of loperamide?

A

Cramps
Nausea and vomiting
Tiredness
Dry mouth

281
Q

Drugs that can exacerbate incontinence?

A

Alpha-1 antagonists (doxazosin)
Antipsychotic
Anticholinergics
Anti-Parkinson’s
Antidepressants
Benzodiazepines
Beta blockers
Diuretics
HRT

282
Q

What to rule out with nocturnal enuresis?

A

UTIs
Constipation
Diabetes

283
Q

Physiological Causes of nocturnal enuresis?

A

Insufficient secretion of ADH at night
Impaired brain arousal
Bladder dysfunction

284
Q

Non-pharmacological management of nocturnal enuresis?

A

Adequate fluid intake
Appropriate toileting especially before bed
Healthy diet
Rewards system
Enuresis alarm

285
Q

Drug of choice for nocturnal enuresis?

A

Desmopressin

286
Q

When to offer desmopressin for nocturnal enuresis?

A

If rapid onset or short term improvement is the priority of treatment or an alarm is inappropriate

287
Q

Desmopressin dose for nocturnal enuresis?

A

200mcg desmotabs or 120mcg desmomelt to start
If not completely dry in one to two weeks can double dose
Assess at four weeks and if positive then continue for three months

288
Q

How does desmopressin work?

A

It is an analogue of ADH
Selective to V2 in distal kidney tubule to increase water reabsorption

289
Q

Advice for taking desmopressin?

A

Risk of hyponatraemic convulsions
Avoid fluid overload
Stop taking during episodes of diarrhoea and vomiting until fluid balance normal
Advise to limit fluid intake one hour before dose and 12 hours after

290
Q

How do Antimuscarinics work for incontinence?

A

M3 cholinergic receptors are responsible for the parasympathetic detrusor contraction in the bladder
So they prevent this action

291
Q

Second line drug therapy for nocturnal enuresis?

A

Antimuscarinics

292
Q

Third line drug therapy for nocturnal enuresis?

A

Imipramine

293
Q

Types of incontinence?

A

Stress
Urgency
Overflow
Mixed

294
Q

What is stress incontinence?

A

Leaks when bladder put under stress (sneeze, cough)

295
Q

What causes stress incontinence?

A

Poorly functioning urethral sphincter muscle or hypermobility of the bladder neck or urethra
Caused by weakening or damage

296
Q

Another name for urgency incontinence?

A

Overactive bladder

297
Q

What is urgency incontinence?

A

A sudden urge to urinate

298
Q

What is overflow incontinence?

A

Bladder doesn’t fully empty

299
Q

What causes urgency incontinence?

A

Overactivity if the detrusor muscles

300
Q

What causes overflow incontinence?

A

Often caused by obstruction or blockage in the bladder

301
Q

Non-pharmacological management of incontinence?

A

Reduce caffeine intake
Moderate fluids
Lose weight if needed
Pelvic floor exercises
Bladder training
Surgery

302
Q

First line drug treatment for incontinence in women?

A

Oxybutynin
Tolterodine
Solifenacin

303
Q

Why are Antimuscarinics often discontinued?

A

Side effects

304
Q

When to avoid Antimuscarinics?

A

Close-angle glaucoma
Diagnosis of dementia
Prostate enlargement
QT prolongation

305
Q

How do B3 agonists work for incontinence?

A

B3 receptors in bladder wall
Activation inhibits detrusor muscle

306
Q

When should mirabegron be used for incontinence?

A

If Antimuscarinics do not work, are unsuitable or intolerable side effects

307
Q

Major safety warning for mirabegron?

A

Contraindicated for severe uncontrolled hypertension
Regular monitoring of BP required

308
Q

How does duloxetine work for incontinence?

A

Increased levels of 5-HT and NE in sacral spinal cord leads to increased urethral tone
Results in stronger urethral closure during urine storage with physical stress

309
Q

When should duloxetine be offered for incontinence?

A

Second line for stress incontinence only if they prefer drug treatment to surgery

310
Q

Why did duloxetine fail US approval for stress incontinence?

A

Liver toxicity
Suicidal events

311
Q

Who are UTIs most common in?

A

Women

312
Q

Who are UTIs most serious in?

A

Men

313
Q

What is the name of an upper urinary tract infection?

A

Pyelonephritis

314
Q

Types of lower UTIs?

A

Cystitis
Urethritis
Prostatitis

315
Q

Usual cause of urethritis?

A

Sexually transmitted

316
Q

Symptoms of a UTI?

A

Increased urinary frequency
Dysuria
Haematuria
Fever
Confusion
Flank pain (pyelonephritis)

317
Q

Why do multistix test for nitrites?

A

Bacteria can convert nitrates to nitrites

318
Q

How to diagnose uncomplicated cystitis?

A

Simple history
Uniralysis

319
Q

First line antibiotic treatment for UTI?

A

Nitrofurantoin 100mg MR BD
3 days women
7 days men

320
Q

Nitrofurantoin should be avoided in a GFR less than?

A

45

321
Q

Second line treatment for UTI?

A

Trimethoprim 200mg BD
Women 3 days
Men 7 days

322
Q

UTI treatment for EBSL producing organisms?

A

Pivmecillinam
Fosfomycin

323
Q

First line treatment for UTI in pregnancy?

A

Nitrofurantoin MR 100mg BD for seven days (not at term)
Or
Amoxicillin 500mg TDS for seven days

324
Q

When should Nitrofurantoin not be used during pregnancy?

A

At term

325
Q

What is classed as a recurrent UTI?

A

More than 3 UTIs in a year

326
Q

Red flags in recurrent UTIs?

A

Haematuria

327
Q

Usual course length for prostatitis?

A

2 weeks. Can continue a further 2 weeks if required

328
Q

First line drug treatment for prostatitis?

A

Ciprofloxacin 500mg BD

329
Q

Why should quinolones be avoided with NSAIDs?

A

Increased seizure risk

330
Q

Acute pyelonephritis treatment?

A
331
Q

Another name for travel health?

A

Emporiatrics

332
Q

Main areas of travel health?

A

Pre-travel health assessments and advice
Medicines and medical related goods to manage/prevent health problems
Vaccinations
Management of health problems in returning travellers

333
Q

Two types of IBD?

A

Ulcerative colitis
Crohn’s disease

334
Q

What is CUTE?

A

colitis of uncertain type or etiology

335
Q

Possible causes of IBD?

A

Genetics
Environment
Smoking
OCP
Appendectomy
Antibiotics
NSAIDs
Diet
Infection
Gut microflora
Host immunity

336
Q

Main differences between Crohn’s disease and ulcerative colitis?

A

Crohn’s is in patches
UC is continuous
Crohn’s can affect any part of GI tract
UC only affects large intestine

337
Q

What part of the GI tract can Crohn’s disease affect?

A

All of it

338
Q

What can Steatorrhoea occur with Crohn’s but not ulcerative colitis?

A

Crohn’s can affect the small intestine

339
Q

Aims of treatment for IBD?

A

Reduce risk of colorectal cancer
Control and relieve symptoms
Minimise toxicity
Address psychological issues
Replenish nutrients
Treat complications
Improve quality of life
Maintain remission
Promote mucosal healing
Reduce intestinal inflammation

340
Q

What are parts of the GI tract not affected by Crohn’s disease called?

A

Skip lesions

341
Q

Peak age of onset for Crohn’s?

A

15-30
And
60-80

342
Q

When are corticosteroids used in IBD?

A

To induce remission, not for maintenance

343
Q

When should aminosalicylates be used in Crohn’s disease?

A

Third line

344
Q

When should aminosalicylates be used in ulcerative colitis?

A

First line

345
Q

Examples of aminosalicylates?

A

Mesalazine, sulfasalzine, olsalazine, balsalazine

346
Q

Which aminosalicylates are pro-drugs?

A

Sulfasalazine, olsalazine, balsalazine

347
Q

How are aminosalicylate pro-drugs metabolised?

A

By bacteria in the gut to form 5-ASA

301 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions