from quesmed

Question 1

drugs CI with sidenafil

Answer 1

Sildenafil is a PDE5 inhibitor and leads to vasodilation of the peripheral vasculature leading to a drop in the blood pressure in a similar way to how nitrates work.
phosphodiesterase 5 (PDE5) inhibitor which enhances the effect of nitric oxide causing smooth muscle relaxation and subsequent penile erection due to inflow of blood.

Question 2

This patient presents with a classical fluctuating GCS on a background of a head injury in the context of alcohol excess, with a CT head that demonstrates a crescent-shaped haemorrhage

Answer 2

sub dural

Question 3

which antibiotic reduces seixure threshold

Answer 3

Ciprofloxacin

Ciprofloxacin and other quinolones can precipitate seizures in patients with or without an underlying seizure disorder. They should be prescribed with extreme caution in patients with epilepsy.

Antibiotics: Imipenem, penicillins, cephalosporins, metronidazole, isoniazid
Antipsychotics
Antidepressents: Bupropion, Tricyclics, Venlafaxine
Tramadol
Fentanyl
Ketamine
Lidocaine
Lithium
Antihistamines

Question 4

tramadol has SNRI affects
is it renally cleared
what are the side effects

Answer 4

A type of opiate not renally cleared. it is metabolsied in the liver

delirium, lower seizure threshold and impotence

Question 5

gait distrubance
urinary incontience
dementia/memory loss

Answer 5

normal pressure hydrocephalus

Question 6

what neurotransmittter does haloperidol block

Answer 6

dopamine by competively blocking dopamine D2 receptors

Question 7

is morphien sulphate long or short acting

Answer 7

Morphine sulphate MR is a long-acting preparation and not appropriate for breakthrough pain relief. so instead give immediate release

if someone is tolerating medications well dont change them

Question 8

from oral to SC morphine what do you do to the dose

Answer 8

oral morphine to subcutaneous morphine, you must divide the total dose by two

Question 9

oral morphien to oral oxycodone

Answer 9

divide by 2

Question 10

oral morphien to fentanil

Answer 10

divide by 150

Question 11

what is an advanced care plan and examples

Answer 11

Advance care planning enables patients to make decisions about their care at a time when they no longer have capacity to do so. This is to ensure that a patient is treated with dignity and their values are respected. Advance care decisions should be specific and the refusal of intravenous antibiotics in the case of a life-threatening infection is a common example of an advance care decision

Question 12

why is gentamicin CI in myasthenia gravis

Answer 12

Gentamicin can cause clinically significant muscle weakness in myasthenia patients resulting in respiratory depression

Question 13

features of delirium

Answer 13

Disorientation
Hallucinations
Inattention
Memory problems
Change in mood or personality
Disturbed sleep

Question 14

causes of delirium

Answer 14

Causes (Mnemonic: DELIRIUMS)
Common causes of delirium can be remembered using the mnemonic DELIRIUMS:

D - Drugs and Alcohol (Anti-cholinergics, opiates, anti-convulsants, recreational)
E - Eyes, ears and emotional
L - Low Output state (MI, ARDS, PE, CHF, COPD)
I - Infection
R - Retention (of urine or stool)
I - Ictal
U - Under-hydration/Under-nutrition
M - Metabolic (Electrolyte imbalance, thyroid, wernickes
(S) - Subdural, Sleep deprivation

Question 15

main cuase of postural hypotension

Answer 15

furosemide

Question 16

psuedo demntia

Answer 16

Also known as depressive dementia, this is an important differential in the elderly, severe depression can lead to psycho-motor slowing, memory impairment and difficulties in concentration similar to dementia in appearance. These patients often present with self neglect and significant weight loss as a result

Question 17

features of pseduo dementia

Answer 17

Short duration of dementia
Equal effect on long and short term memory
Amnesia concerning specific events (often events are emotionally charged)
Often patient will very detailed complaint about memory disturbance
Patient may highlight failures in answers to questions relating to memory
Loss of social skills early in the illness
Patient will often answer “don’t know” to questions, as opposed to guessing close answers
Patient may make little effort in performing tasks

Question 18

What do the deprivation of liberty safeguards (DOLS) refer to?

Answer 18

A means to protect the rights of patients who lack capacity who are detained in a hospital or care home

DOLS refers to the protection of rights of patients detained in a hospital or care home. Such patients should be proven to lack in capacity and express a wish to leave the facility. Such patients should be detained under a DOLS and their rights and values protected

Question 19

An 83-year-old man has had progressive degeneration of his cataracts in both eyes and is now legally blind. He mentions to you that over the last few months he has been noticing visual hallucinations. He mentions these as a curiosity and understands that they are not real but clearly describes tiny cats and dogs walking around the chair behind you. What clinical disorder fits in with his clinical decline?

Answer 19

Charles Bonnet syndrome

Associated with visual loss, these patients often describe smaller versions of real life objects commonly of faces or cartoons. Importantly, they realise that the hallucinations are not real. It is thought that this is due to damage of the visual system itself and is not a mental health disorder. Unfortunately there are little treatments or support to offer besides from reassurance of the patient’s sanity

Question 20

do dopamine agonist such as ropinorol cause galactorrhea

Answer 20

no they suppress lactation

Question 21

infarct

Answer 21

area of dead cells in tissue

Question 22

emboli in the opthalamic artery causing amaurosis fungax - transient vision loss that appears like a shade or curtain descending associated with blurring or dimming associated with what cause

Answer 22

artersclerosis of carotid artery

Question 23

stroke has been diangosed by CT what other investigations can you do to determine underlying cause

Answer 23

USS/doppler of carotid arteries- stenosis or dissection
ECG and echo - AF or clots
holter monitor - abnromal rythm
if bleed was thought to have originated from an aneurysm or arteriovenou smalformation then could do angio of cerebral vasculature
blood test to check cholesterol, bleeding or homocystinuria ( body can’t process the amino acid methionine)