Data Interpretation

Question 1

Give 2 side effects of clozapine that require monitoring

Answer 1

Agranulocytosis

Neutropenia

(Pts require monthly blood tests to monitor)

Question 2

Give 1 side effect of Carbimazole (antithyroid)

Answer 2

Neutropenia

Question 3

What 4 causes of Hypokalaemia

Answer 3

DIRE

Drugs - Thiazide/Loop Diuretics

Inadequate intake/Intestinal loss (diarhoea/vomiting)

Renal tubular Acidosis

Endocrine - Cushing’s/Conn’s Syndrome

Question 4

Give 5 causes of Hyperkalaemia

Answer 4

DREAD

Drugs - ACEi + Aldosterone Antagonists (K+ Sparing diuretics)

Renal Failure

Endocrine - Addison’s

Artefact - Clotted sample

DKA

Question 5

Give 2 causes of a raised Urea

Answer 5

AKI

Upper GI bleed

Question 6

A raised urea without an increase in creatinine indicates what?

Answer 6

A non-renal cause

Question 7

Regarding AKI, if Urea rise is > than creatinine, what type of AKI is it?

Answer 7

Pre-renal AKI

Question 8

Regarding AKI, if Urea rise is < than creatinine, what type of AKI is it?

Answer 8

Intrinsic or post-renal AKI

Question 9

What issue usually causes pre-renal AKI?

Answer 9

Perfusion issue

Question 10

What issues can cause intrinsic AKI? (5)

Answer 10

Ischaemia (causing acute tubular necrosis)

Nephrotoxic antibiotics (gentamicin, vancomycin, doxycycline)

Drugs - ACEi, NSAIDs

Radiological contrast

Injury - Rhabdomyolysis

Question 11

What issue usually causes post-renal AKI?

Answer 11

Obstruction issue (i.e blocked catheter)

Question 12

What biomarkers would be raised in pre-hepatic pathology?

Answer 12

Isolated raise in bilirubin

Question 13

What biomarkers would be raised in intrahepatic pathology?

Answer 13

Increased Bilirubin

Increased ALT/AST

Question 14

What biomarkers would be increased in post-hepatic pathology?

Answer 14

Increased bilirubin

Increased ALP/gGT

Question 15

Thyroid Function Tests - High TSH and Low T4 indicates what?

Answer 15

Primary Hypothyroidism

(Hashimoto’s, Drug Induced)

Question 16

Thyroid Function Tests - Low TSH and High T4 indicates what?

Answer 16

Primary Hyperthyroidism

(Grave’s, Toxic Multinodular Goitre, Drugs)

Question 17

Thyroid Function Tests - Low TSH and Low T4 indicates what?

Answer 17

Secondary hypothyroidism

(Pituitary Tumour/Damage)

Question 18

Thyroid Function Tests - High TSH and High T4 indicates what?

Answer 18

Secondary Hyperthyroidism

Pituitary Tumour

Question 19

Give 6 drugs with a narrow therapeutic range that require monitoring

Answer 19

Digoxin

Theophylline

Lithium

Phenytoin

Gentamicin

Vancomycin

Question 20

Drug monitoring - If an adequate therapeutic effect is achieved and serum concentration levels are high, what should be done to the dose?

Answer 20

Reduce dose

Question 21

Drug monitoring - If an adequate therapeutic effect is achieved and serum concentration levels are normal/low, what should be done to the dose?

Answer 21

No dose change

Question 22

Give 4 features of digoxin toxicity

Answer 22

Confusion

Nausea

Visual Halos

Arrhythmias

Question 23

Give 5 features of lithium toxicity

Answer 23

Tremor

Tiredness

Seizures

Coma

Diabetes Insipidus

Question 24

Give 5 features of Phenytoin Toxicity

Answer 24

Gum Hypertrophy

Ataxia

Nystagmus

Peripheral Neuropathy

Teratogenic

Question 25

Give 2 features of gentamicin/vancomycin toxicity

Answer 25

Ototoxicity Nephrotoxicity

Question 26

What liver product is required for paracetamol metaboliosm?

Answer 26

Glutathione (antioxidant)

Question 27

What happens to Glutathione stores in paracetamol overdose? What effect does this have on the liver? (3)

Answer 27

Stores are quickly depleted. Leads to accumulation of toxic metabolites - NAPQI NAPQI causes acute liver damage

Question 28

What is the treatment for paracetamol overdose? How is this achieved?

Answer 28

N-Acetyl-Cysteine (NAC) NAC replenishes stores of Glutathione, thus preventing further production of NAPQI and preventing further liver damage.

Question 29

Reversal of Warfarin - How should major bleeding be managed? (3)

Answer 29

Stop Warfarin IV Vitamin K 5mg Prothrombin Complex

Question 30

Reversal of Warfarin - How should minor bleeding be managed + INR >8 ? (2)

Answer 30

Stop Warfarin IV Vitamin K 1-3mg

Question 31

Reversal of Warfarin - How should no bleeding but an INR >8 be managed? (2)

Answer 31

Stop Warfarin Oral Vitamin K 1-5mg

Question 32

Reversal of Warfarin - How should minor bleeding + INR 5-8 be managed? (2)

Answer 32

Stop Warfarin IV vitamin K 1-3mg

Question 33

Reversal of Warfarin - How should INR 3-5 + no bleeding be managed? (1)

Answer 33

Omit doses of Warfarin until INR <3

Question 34

What effect do macrolides (erythromycin/clarithromycin) have on Warfarin? What effect does this have on INR?

Answer 34

Macrolides are enzyme inhibitors so increase effects of Warfarin (Increase INR)

Question 35

How can Carbamazepine cause hyponatraemia?

Answer 35

Inducing SIADH

Question 36

In a patient with Addison's or who is on Long Term Steroids, what should be done during intercurrent illness?

Answer 36

Increase hydrocortisone

Question 37

What is the mainstay treatment for acute heart failure with signs of fluid overload? (Pulmonary oedema, Raised JVP, Peripheral Oedema)

Answer 37

40mg IV Furosemide

Question 38

What are the 2 first line drugs for rate control in fast AF? Give 2 contraindications to look out for

Answer 38

Betablockers and Diltiazem BB - Asthma CCB - Peripheral oedema/leg swelling