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Drugs Flashcards

1
Q

Target INR for venous thromboembolism, and target for recurrent thromboembolism

A

venous thromboembolism: 2.5

recurrent thromboembolism: 3.5

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2
Q

Target INR for atrial fibrillation

A

2.5

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3
Q

What is the INR?

A

Ratio of prothrombin time of the patient over the normal prothrombin time

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4
Q

Factors that may potentiate warfarin

A

Liver disease
P450 enzyme inhibitors: e.g. amiodarone, ciprofloxacin, cranberry juice
Drugs, which displace warfarin from plasma albumin e.g. NSAIDS

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5
Q

This drug can cause purple toes

A

Warfarin

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6
Q

Warfarin and pregnancy/breast feeding

A

Teratogenic so avoid in pregnancy, but can be used in breastfeeding

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7
Q

What drugs does clopidogrel interact with?

A

Interacts with PPIs

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8
Q

How does Fondaparinux work?

A

Activates antithrombin III

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9
Q

Statin monitoring?

A

LFTs at baseline, 3 months and 12 months

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10
Q

Hypocalcaemia is a side effect of which type of diuretic?

A

Loop diuretic

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11
Q

Which drugs are associated with angioedema?

A

ACE inhibitors

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12
Q

Which antibiotic should you avoid if you have long QT?

A

Erythromycin

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13
Q

Triad for Boerhaave syndrome?

A

Vomiting, thoracic pain, subcutaneous emphysema

commonly presents in middle aged men with a background of alcohol abuse

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14
Q

A 52-year-old male presents with tearing central chest pain. On examination he has an aortic regurgitation murmur. An ECG shows ST elevation in leads II, III and aVF.

A

Proximal aortic dissection

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15
Q

A 52-year-old male presents with central chest pain and vomiting. He has drunk a bottle of vodka. On examination there is some mild crepitus in the epigastric region.

A

Boerhaave syndrome

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16
Q

Dipyridamole mechanism of action

A

Inhibits phosphodiesterase, elevating cAMP levels, which in turn reduce intracellular calcium levels

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17
Q

Ototoxicity is a side effect of which type of diuretic?

A

Loop diuretic

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18
Q

What type of drug is infliximab?

A

Monoclonal antibody - anti-tnf

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19
Q

What type of drug is adalimumab?

A

Monoclonal antibody - anti-tnf

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20
Q

What type of drug are ciclosporin and tacrolimus?

A

Calcineurin inhibitors

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21
Q

Side effects of tamsulosin

A 
Dizziness, drowsiness, weakness
Nausea and diarrhoea
Headache, chest pain
Abnormal ejaculation - decreased amount of sperm
Back pain
Blurred vision
Fever, chills, aches, flu symptoms
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22
Q

How many units of alcohol can you drink?

A

Do not exceed more than 14 units per week, try to spread these over 3 days or more

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23
Q

Barrets oesophagus increases the risk of which type of cancer?

A

Adenocarcinoma

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24
Q

Achalasia increases the risk of which type of cancer?

A

Sqaumous cell

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25
Q

Lesions anywhere from mouth to anus

A

Crohn’s

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26
Q

Skip lesions

A

Crohn’s

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27
Q

Granulomas UC or Crohn’s?

A

Crohn’s

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28
Q

Transmural inflammation

A

Crohn’s

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29
Q

Pseudopolpys UC or Crohn’s

A

UC

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30
Q

A 43-year-old man with a history of Peutz-Jeghers syndrome presents with diarrhoea and rectal bleeding for the past ten days. On examination he has brown pigmented lesions on his lips and palms but abdominal and rectal examination is unremarkable. What is the most likely cause for this presentation?

A

Colon cancer

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31
Q

Is weight loss a feature of IBS?

A

NO!!!! Need to investigate

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32
Q

Which condition increases your risk of developing enteropathy associated T cell lymphoma

A

Coeliac disease

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33
Q

A 24-year old female presents to general practice with a few-weeks history of diarrhoea, passage of mucus, lethargy and abdominal discomfort relieved by defaection

A

IBS

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34
Q

First line anti-motility agent for diarrhoea in IBS?

A

Loperamide

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35
Q

Treatment for haemochromatosis

A

Vensection

36
Q

A barium swallow which shows a grossly expanded oesophagus that tapers at the lower oesophageal sphincter (‘bird’s beak’ appearance)

A

Achalasia

37
Q

Why are people with coeliac disease offered an annual pneumococcal vaccine?

A

They have hyposplenism

38
Q

A 76-year-old woman presents with abdominal pain, distension and vomiting. She recently had an episode of acute cholecystitis and is awaiting a cholecystectomy. She feels her symptoms have returned over the past few days. On examination her abdomen is distended.

A

Gallstone ileus

39
Q

A 62-year-old presents with upper abdominal pain. She has recently been discharged from hospital where she underwent an ERCP to investigate cholestatic liver function tests. The pain is severe. On examination she is apyrexial and has a pulse of 96 / min.

A

Acute pancreatitis

40
Q

A 57-year-old woman with a history of gallstones presents with progressive right upper quadrant pain, rigors and jaundice.

A

Ascending cholangitis

41
Q

A 48-year-old female presents to the GP with a lump in throat. She can swallow foods and liquids normally if she tries, although she has noticed the discomfort is worse on swallowing saliva. She does not have any pain on swallowing, chest pain or heart burn. Her appetite is normal.

A

Globus (the feeling of having a lump in the throat)

42
Q

Primary sclerosing cholangitis is most associated with

A

Ulcerative colitis

43
Q

If you are having endoscopy when should you stop taking omeprazole?

A

Stop taking 2 weeks before

44
Q

Investigation of choice for liver cirrhosis

A

Transient elastography

45
Q

Treatment for Wilson’s disease?

A

Penicillamine

46
Q

Melanosis coli is a disorder of pigmentation of the bowel wall. Histology demonstrates pigment-laden macrophages. When would you see this?

A

Laxative abuse

47
Q

An 8-year-old boy presents with classical appendicitis pain, that has migrated from the umbilicus to the right iliac fossa within the last 12 hours. When the doctor palpates the left iliac fossa, the boy feels pain in the right iliac fossa. What is the name of this eponymous sign?

A

Rosving’s sign

48
Q

McBurney’s point

A

The site where the pain from appendicitis is usually most severe on palpation. The point is on the right side of the abdomen, approximately one-third of the distance from the anterior superior iliac spine to the umbilicus

49
Q

Kernig’s sign

A

Positive when the thigh is flexed at the hip and knee at 90-degree angles and subsequent extension of the knee elicits pain. This can be indicative of meningism of subarachnoid haemorrhage.

50
Q

Psoas sign

A

Patient lies on their left side and the clinician extends the right hip with the knee fully extended. Abdominal pain on this movement indicates irritation of iliopsoas and possible appendicitis. This test usually indicates an appendix that lies in the retrocaecal position

51
Q

Most common cause of hepatocellular cancer in a) europe b) worldwide

A

Europe - hep c

Worldwide - hep b

52
Q

A transjugular intrahepatic portosystemic shunt (TIPS) procedure connects which veins?

A

Connects the portal vein to the hepatic vein

53
Q

jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules

A

Whipple’s disease

54
Q

Anti-smooth muscle and anti-nuclear antibodies?

A

Autoimmune hepatitis

55
Q

A 38-year-old woman presents with fever, malaise and jaundice. On examination she has moderate hepatomegaly. Laboratory analysis confirms a positive anti-smooth muscle antibody and anti-nuclear antibody. Antimitochondrial antibodies are negative.

A

Autoimmune hepatitis

56
Q

What is peabodys sign

A

Peabody’s sign is clinically found in patients with a deep vein thrombosis (DVT) and a positive test indicated by calf muscle spasm occurring on elevation and foot extension of the affected leg

57
Q

What is virchows node

A

Virchow’s node is an enlarged left supraclavicular lymph node seen in various internal abdominal malignancies

58
Q

Why do you prescribe lactulose in hepatic encephalopathy?

A

Decreases production of ammonia in the intestines

Neomycin also licensed –> kills the bacteria that make ammonia

59
Q

A 64-year-old man presents to his GP due to lethargy, anorexia and altered bowel habit. On examination he is noted to have non-tender hepatomegaly with a nodular edge. What is the likely diagnosis?

A

Metastatic cancer

60
Q

What must you do before you take someone to surgery for appendicitis?

A

Give them broad spectrum antibiotics to reduce chances of post op complications

61
Q

A 40-year-old man presents with symptoms of dysphagia that have been present for many months. His investigations demonstrate lack of relaxation of the lower oesophageal sphincter during swallowing.

A

Achalasia

62
Q

Primary sclerosing cholangitis is associated with which antibodies?

A

ANCA and anti-smooth muscle cell antibodies

63
Q

IgA and IgA TTG

A

Coeliac

64
Q

Gold standard test for oesophageal cancer

A

Endocscopy

65
Q

What is toxic megacolon?

A

Transverse colon >6cm

66
Q

hamartomatous polyps in GI tract (mainly small bowel)
pigmented lesions on lips, oral mucosa, face, palms and soles
intestinal obstruction e.g. intussusception
gastrointestinal bleeding

A

Peutz Jeghers

67
Q

Crypt abscesses

A

Ulcerative colitis

68
Q

CRP and Crohn’s disease?

A

CRP correlates with disease activity

69
Q

Kantor’s string sign?

A

Crohn’s

70
Q

This TB medication can can cause a vitamin B6 deficiency causing peripheral neuropathy

A

Isoniazid

71
Q

Following NICE guidance, what is the most appropriate way to screen for harmful alcohol drinking and alcohol dependence?

A

AUDIT questionnaire

72
Q

When might you measure fecal calprotectin?

A

E.g. when you’re trying to distinguish between IBD and IBS (fecal calprotectin raised in inflammation)

73
Q

μ-opioid receptor agonist which does not have systemic effects as it is not absorbed through the gut

A

Loperamide

74
Q

HNPCC increases risk of which type of cancers?

A

Colorectal and endometrial

75
Q

Reduced serum caeruloplasmin

A

Wilsons

76
Q

Which type of MEN is associated with Zollinger Ellison syndrome?

A

MEN I

77
Q

What is Zollinger Ellison syndrome?

A

Zollinger-Ellison syndrome is condition characterised by excessive levels of gastrin, usually from a gastrin secreting tumour usually of the duodenum or pancreas. Around 30% occur as part of MEN type I syndrome

78
Q

Which diabetes medication is most likely to cause cholestasis?

A

Gliclazide

79
Q

Most common site affected in UC?

A

Rectum

80
Q

The biggest risk factor for developing Barretts?

A

GORD

81
Q

The three types of colon cancer

A

sporadic (95%)
hereditary non-polyposis colorectal carcinoma (HNPCC, 5%)
familial adenomatous polyposis (FAP, <1%)

82
Q

What is the most appropriate test to confirm H. pylori eradication?

A

Urea breath test

83
Q

Tinkling bowel sounds

A

Small bowel obstruction

84
Q

What can you use octreotide for?

A

Used to treat the symptoms of carcinoid syndrome

Used in acromegaly

85
Q

What is memantine

A

An NMDA antagonist
Used in Alzheimers
Reduces levels of glutamate

Drugs (12 decks)

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