Imperial PPQs Flashcards
September 2023
Important information to tell patient when starting on lymecycline for acne
Commonly causes photosensitivity
Prescription for insomnia after husband died
September 2023
Side effects commonly caused by Estradiol 2mg PO daily (oestrogen HRT)
Gastrointestinal discomfort and weight changes
September 2023
Patient with PCOS referred for transvaginal ultrasound scan. What needs to be prescribed?
September 2023
Maximum daily dose of ramipril
10mg PO daily
Initially: 1.25–2.5 mg once daily,
September 2023
Treatment of IDA on a background of coeliac disease
Ferrous sulphate / fumarate / gluconate
For 3 months AFTER the iron deficiency is corrected to replenish stores.
September 2023
What is the approproate treatment regimen for paracetamol overdose requiring NAC?
Admit and commence N-Acetylcysteine 150 mg/kg IV over 1 hour immediately followed by 50 mg/kg IV over 4 hours, then 100 mg/kg IV over 16 hours.
Activated charcoal is considered only if the patient presents within 1 hour of ingesting paracetamol in excess of 150mg/kg, which is not the case here. Delaying treatment is not appropriate if paracetamol levels are above the treatment line.
September 2023
Patient with opioid dependence failed to improve on buprenorphine. What can be tried next?
Methadone hydrochloride
September 2023
Common side effect on initiation of morphine
Vomiting
September 2023
Patient with painful haemorrhoids - which laxative is most appropriate?
Bulk-forming laxative e.g. Ispaghula Husk,
September 2023
Which vaccines should pregnant women get?
Annual flu vaccinatin
Whooping cough vaccine
September 2023
Thromboprophylaxis for patient undergoing total knee replacement
Either low-dose aspirin for 14 days, or a low molecular weight heparin administered for 14 days in combination with anti-embolism stockings until discharge, or rivaroxaban.
September 2023
Most objective way to monitor for dehydration?
Urine output
Other components of fluid status assessment: JVP, mucous membranes, skin turgor, temperature
September 2023
If diabetes is not well controlled on metformin alone, what can be added?
Examples:
pioglitazone 15mg PO OD
sitagliptin 100mg PO OD
September 2023
If someone on levothyroxine has a TSH below the normal range, what is the most appropriate action?
Reduce the dose of levothyroxine by 25micrograms (smallest possible amount)
This should be followed by a repeat blood test in 6-8 weeks.
Should ONLY reduce the dose by a large amount (e.g. 50micrograms) if the patient is overtly thyrotoxic.
September 2023
Treatment of suspected PE (before it is confirmed)
September 2023
A 78-year-old woman on the acute admissions unit requires a dose of intravenous lorazepam for an acute panic attack. The dose of lorazepam is 30 micrograms/kg every 6 hours as required. Weight 50 kg. Intravenous lorazepam is available as a 2mg / 1 ml solution for injection.
What volume (mL) of intravenous lorazepam should the patient be given for her first dose?
0.75ml
September 2023
Appropriate fluid resuscitation for 89 year old female with likely chest sepsis
500mL 0.9% sodium chloride
September 2023
Which antibiotic should be given for a UTI in pregnancy (38+2/40)?
Cefalexin 500mg PO twice daily for 7 days
September 2023
Whcih oral analgesia following an open reduction and internal fixation (ORIF) of the distal radius following an accident (Currently paracetamol + NSAIDs not managing pain)?
Weak opioid e.g. codiene
October 2023
Management of ‘gurgling’ noises while breathing + distress at the end of life (despite repositioning regularly)
Management of respiratory secretions
Glycopyrronium bromide 600 micrograms SC over 24 hours
October 2023
When should alendronic acid be de-prescribed in elderly patients?
If a patient has been on the medication for over 10 years
October 2023
What is the treatment for whooping cough?
An oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) is indicated if the onset of the cough is within the previous 21 days to eradicate the organism and reduce the spread
October 2023
When patients are started on carbimazole, how should the dose be adjusted?
Patients should continue on 15-40mg of carbimazole until euthyroid.
Once euthyroid, gradually reduce to 5-15 mg PO daily (titrated to TFTs) and is usually required for 12-18 months.
October 2023
What is the ‘block and replace’ regime for Graves’ disease?
Carbimazole 40mg is started and thyroxine is added when the patient is euthyroid.
October 2023
What is the initial dose of carbimazole?
15mg PO OD
(up to 40mg PO OD)
October 2023
Why is propylthiouracil not used firstline with carbimazole for Graves?
NICE states ‘Propylthiouracil is usually not used first-line, due to a small risk of severe liver injury, except in certain circumstances such as pre-pregnancy or the first trimester of pregnancy, or for specialist treatment of thyrotoxic crisis. It may be used second line if carbimazole is not tolerated.’
October 2023
What is offered to patient in the early stages of Parkinson’s disease to control symptoms?
Levodopa 250mg PO twice daily
Selegiline (E) is an oral monoamine oxidase-B inhibitor, and typically provides less improvement in motor symptoms and daily functioning. Given that these motor problems seem to be most debilitating for the patient, this is not the most appropriate therapy at this stage, though may be offered later.
Ropinirole (D) is an oral dopamine agonist and also a possible first-line therapy. However, like selegiline it typically provides less improvement in motor symptoms than levodopa.
Amantadine (A) is a second line drug used if dyskinesia is not sufficiently improved following a first line therapy.
Entacapone (B) is also a second line drug used as an adjunct to levodopa if motor symptoms persist.
October 2023
Treatment of acute migraine
Sumatriptan 100mg PO once only
October 2023
Patient on Microgynon 30 one tablet PO daily (started 3 months ago) found to have hypertension >160/90mmHg. What should you do?
Switch Microgynon to Cerazette 75 micrograms PO daily
October 2023
Prescription for the treatment of Bell’s Palsy
Prednisolone 50mg PO OD
October 2023
How to treat reflux in breastfed infant?
Alginate therapy (e.g. Gaviscon) following every feed.
For children 1-23 months (body weight 4.5kg and above): 2 sachets as required - to be mixed with feeds (or water, for breastfed infants). Max. 12 per day.
October 2023
How often should children with T1DM initially measure capillary glucose?
5 or more times per day
More frequently during periods of physical activity and during intercurrent illness
October 2023
What is the first-line treatment of incontinence with the following results on urodynamic studies: detrusor overactivity with involuntary contraction of the bladder during filling?
a.k.a. urge incontinence
Oxybutynin hydrochloride
(Or tolterodeine)
Gliclazide can cause hypoglycaemia so she must eat regular meals.
October 2023
What is the drug + dose for opioid toxicity?
Naloxone hydrochloride 400 micrograms intravenous once only
Naloxone 400 micrograms intravenous once
October 2023
What is the most effective long-term treatment for bipolar disorder?
Lithium
Other names: lithium carbonate, Camcolit, Priadel (tablets)
October 2023
What is the definition of gestational diabetes?
Fasting plasma glucose level of 5.6 mmol/L or above; or Two-hour plasma glucose level of 7.8 mmol/L or above.
October 2023
How should you manage gestational diabetes if fasting plasma glucose is below 7mmol/litre at diagnosis? And if this fails?
Women with gestational diabetes who have a fasting plasma glucose below 7 mmol/litre at diagnosis, should first attempt a change in diet and exercise alone in order to reduce blood glucose.
If blood glucose targets are not met within 1 to 2 weeks, metformin hydrochloride may be prescribed. Insulin may be prescribed if metformin is contraindicated or not acceptable and may also be added to treatment if metformin is not effective alone.
The starting dose for Metformin is 500mg once daily for one week, which can be tapered up according to response to treatment.
November 2023
What is the most likely adverse effect of furosemide daily (for symptomatic relief of heart failure)?
Dizziness secondary to dehydration
November 2023
For a patient with a QRISK score of over 10%, what should they be started on?
Atorvastatin 20mg PO once a day (at night)
November 2023
What is the dose of adrenaline for a child 1-5 years old?
150micrograms
November 2023
Hypoglycaemia in patient with no IV access, drowsy and disoriented.
Glucagon 1mg IM STAT
This is the most appropriate option given the circumstances of concern over swallow (reduced GCS) and lack of IV access. Glucagon can be given immediately here through IM administration and avoids any delay in treatment caused by attempting to site a cannula. A cannula should be sited ASAP (as the patient will require IV glucose) but not at the expense of treating the hypoglycaemia.
November 2023
Patient in hospital for acute asthma attack. Has been given salbutamol neb. What else can be given acutely to further help with wheeze?
Ipratropium bromide 500 micrograms nebulised
November 2023
When and how should rivaroxaban be taken?
WIth food (to maximise absorption)
At the same time each day.
November 2023
What are the options that can be given for generalised anxiety disorder?
November 2023
Which drugs are NOT normally stopped before surgery?
Drugs that should normally not be stopped before surgery include antiepileptics, antiparkinsonian drugs, antipsychotics, anxiolytics, bronchodilators, cardiovascular drugs (but see potassium-sparing diuretics, angiotensin-converting enzyme inhibitors, and angiotensin-ll receptor antagonists), glaucoma drugs, immunosuppressants, drugs of dependence, and thyroid or antithyroid drugs.
November 2023
When should metformin be stopped prior to surgery?
If the patient will miss more than one meal or there is significant risk of the patient developing AKI
A variable rate intravenous insulin infusion should be started if the metformin hydrochloride dose is more than once a day. Otherwise, insulin should only be started if blood-glucose concentration is >12mmol/litre on two consecutive occasions.
Metformin should not be recommenced until the patient is eating and drinking again, and normal renal function has been assured.
November 2023
Which contraceptive pill is most appropriate for a patient over the age of 35 that smokes >15/day?
Any progesterone only pill
November 2023
What is the most likely side effect of clonazepam?
Drowsiness
Correct answer - Drowsiness. Clonazepam is a benzodiazepine. One of the most common side effects of benzodiazepines is drowsiness. It is worth noting that clonazepam is the second line medication used in myoclonic seizures.
November 2023
What is the treatment for impetigo?
NICE CKS recommends hydrogen peroxide 1% cream for ‘people who are not systemically unwell or at a high risk of complications’.
However if this is unsuitable a topical antibiotic may be appropriate, fusidic acid 2% apply three times a day for 5 days, or Mupirocin 2% apply three times a day for 5 days if fusidic acid resistance is suspected or confirmed.
November 2023
If a child is dehydrated (e.g. due to gastroenteritis), how should you rehydrate them?
ORAL fluid challenge
November 2023
Prevention of gout relapses (with doses)?