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)?
November 2023
How is the dose of gentamicin calculated?
Gentamicin should be given at 5-7mg/kg and the dose rounded to the nearest 20mg.
The maximum dose will vary depending on local guidelines but should not exceed 500mg (in some trusts the maximum dose is 480mg so check your local guidelines). In obese patients the calculation should be based on ideal body weight rather than actual body weight. Doses need to be reduced in cases of impaired renal function and patients weighing <40kg.
November 2023
What is the management of GI bleeding WITHOUT varices?
In patients without varices (as in this case), NICE states “offer proton pump inhibitors to patients with non-variceal upper gastrointestinal bleeding and stigmata of recent haemorrhage shown at endoscopy”. PPIs should not be started until after the endoscopy in suspected non-variceal bleeds. The IV PPI used most often is omeprazole, but esomeprazole is an alternative listed in the BNF. IV pantoprazole is not typically used in this instance (although it can be used for Gl ulceration).
November 2023
How is a suspected variceal bleed managed?
In suspected variceal bleeds, patients should be treated immediately with terlipressin and prophylactic antibiotics prior to endoscopy
What is the most appropriate parameter to measure regularly after starting the COCP?
Body mass index
When should antibiotics be prescribed for mastitis and what should be prescribed?
July 2023
When is pioglitazone contraindicated?
Risk of bladder cancer
When would you avoid prescribing gliclazide?
Elevated BMI (risk of further weight gain)
July 2023
A patient has had multiple exacerbations of his COPD despite treatment with a LABA and ICS. What should be added?
LAMA e.g. tiotropium
July 2023
For a patient presenting with clinical features of alcohol withdrawal, what should be given?
Benzodiazepine
Both chlordiazepoxide and diazepam are licenced for the use of alcohol-related withdrawal symptoms in the UK.
This is because long-acting benzodiazepines with active metabolites (such as chlordiazepoxide and diazepam) have a lower chance of recurrent withdrawal or seizures due to missed doses than shorting acting benzodiazepines. A notable exception is in patients with severe liver impairment, where a shorter acting benzodiazepine such a lorazepam may be preferred - this should only be prescribed by a specialist team.
July 2023
When should lorazepam be used for alcohol withdrawal?
severe liver impairment
Both chlordiazepoxide and diazepam are licenced for the use of alcohol-related withdrawal symptoms in the UK. This is because long-acting benzodiazepines with active metabolites (such as chlordiazepoxide and diazepam) have a lower chance of recurrent withdrawal or seizures due to missed doses than shorting acting benzodiazepines. A notable exception is in patients with severe liver impairment, where a shorter acting benzodiazepine such a lorazepam may be preferred - this should only be prescribed by a specialist team.
July 2023
If a patient has renal colic and does not want IM NSAID or PO (because of vomiting), what other route is possible?
PR
It is common to give NSAIDs PR for patients with renal colic given that they often feel nauseated and may vomit.
July 2023
What is the first line antibiotic for tonsillitis?
Phenoxymethylpenicillin
July 2023
If a patient’s eczema hasn’t responded to 1% hydrocortisone cream and regular emollients, what can be offered?
moderately potent topical corticosteroid, such as clobetasone butyrate 0.05%.
July 2023
How can you calculate the correction factor for insulin adjustments?
A correction factor (CF) is an estimate of how much 1 unit of rapid acting insulin will lower someone’s blood glucose. It can be calculated by dividing 100 by the total daily dose (TDD) of insulin.
For this patient the usual TDD is therefore:
18 (18 units of Insulin Glargine once daily) + 21 (7 units of Novorapid three times daily) = 39.
This patient’s CF is therefore 100/39 = ~2.5.
So for every 1 unit of rapid acting insulin, this patient’s blood glucose will fall by approximately 2.5 mmol/L. This patient therefore requires approximately 4 units of Novorapid to bring their blood glucose back in to normal range.
For a child with a fever and cough that appears otherwise well, what can be given (if anything)?
The most appropriate first step would therefore be to prescribe an antipyretic, such as paracetamol. The dose of paracetamol for a child 4-5 years old is 240mg every 4-6 hours up to a maximum of 4 doses per day.
What is the treatment of dendritic ulcer typical of ocular herpes simplex infection (herpes simplex keratitis)?
Treatment is with an antiviral ointment (either aciclovir or ganciclovir). Steroid eyedrops (such as dexamethasone) may be used cautiously by specialists in cases of necrotising stromal keratitis but should otherwise be avoided due to the risk of transforming a simple dendritic ulcer into an extensive amoeboid ulcer involving all layers of the cornea or aggravating secondary infections.
July 2023
What is the treatment for Pneumocystis pneumonia (PCP)?
Cotrimoxazole
https://bnf.nice.org.uk/treatment-summary/pneumocystis-pneumonia.html
July 2023
What is the typical presentation of PCP pneumonia?
Worsening SOB for weeks, non-productive cough, fever, night sweats
No improvement with oral antibiotics
History of HIV
May have oral thrush too
July 2023
Poorly controlled OA despite regular paracetamol - what next?
The next appropriate step would therefore be the addition of a topical NSAID (which are particularly useful for hand and knee OA). If topical NSAIDs were not effective, they should be stopped and oral NSAIDs or weak opioids could then be tried.
July 2023
When is it reasonable to prescribe antibiotics for otitis media?
If symptoms have not resolved within 3 days despite regular use of paracetamol and ibuprofen, it would be reasonable to prescribe antibiotics.
Amoxicillin is first choice.
July 2023
How is pityriasis versicolor described?
After sun exposure (e.g. being on holiday)?
Asymptomatic with no pruritis
Hyperpigmented and hypopigmented macular lesions and patches, with fine overlying scale
July 2023
How is pityriasis versicolor treated?
If an extensive area is involved, prescribe an antifungal shampoo such as: Ketoconazole 2% shampoo
If only small areas are involved, consider prescribing an antifungal cream as an alternative: Imidazole creams (such as clotrimazole [preferred in pregnancy], econazole, or ketoconazole) can be applied twice a day for up to 2–3 weeks.
July 2023
When can oral steroids be prescribed in Bell’s palsy patients?
Oral steroids should be given to people presenting within 72 hours of the onset of symptoms.
Which drugs are licensed for DVT? What are the caveats?
Apixaban, dabigatran, edoxaban and rivaroxaban
However, both dabigatran and edoxaban require the patient to have been given 5 days of parental anticoagulation (such as with a subcutaneous LMWH) prior to initiation.
July 2023
Which drugs to give for VTE prophylaxis?
subcutaneous LMWH (such as dalteparin, tinzaparin or enoxaparin
July 2023
What is the mainstay of treatment for symptomatic hypercalcaemia?
Aggressive intravenous fluid therapy.
The total fluid input for patients with symptomatic or severe hypercalcaemia should be 4-6L over 24 hours. Bisphosphonates may be used only when the patient has been adequately hydrated.
July 2023
If a patient is likely to be taking prednisolone for a long time, what should be prescribed
This patient is receiving a high-dose of corticosteroid and is likely to continue doing so for a prolonged period (at least 3 months). She is therefore at high-risk of developing osteoporosis and prophylaxis should be prescribed alongside her prednisolone. Alendronate (alendronic acid) is first line in this case
July 2023
Definition of HHS
blood glucose of >33.3 mmol/L, a serum osmolality of >320 mmol/kg and volume depletion in the absence of significant ketoacidosis (pH> 7.3, HCO3 > 15 mol/L, ketones negative).
July 2023
How much fluid do patients with HHS require?
Patients will routinely require 3-6 litres of fluid within 12 hours to correct their fluid deficit
In this situation giving 1L sodium chloride 0.9% over 1 hour would be appropriate in the first instance.
How quickly can glucose be replaced in HHS?
The blood glucose should not be reduced by more than 5 mmol/hour. Insulin should only be started once the glucose has stabilised following adequate rehydration.
July 2023
Poorly controlled asthma despite the use of a short-acting beta2-agonist (SABA, salbutamol) and an inhaled corticosteroid (ICS, beclomethasone) - what is the next step?
a leukotrine receptor antagonist (LTRA e.g. montelukast).
July 2023
Treatment of VT?
Amiodarone 300mg IV over 20 minutes
July 2023
Treatment of Lyme disease?
Treatment is usually with oral doxycycline for 21 days, except in cases where the central nervous system is involved where IV ceftriaxone can be used as an alternative.
July 2023
Treatment of Torsades de Pointes?
Magnesium sulfate IV 2g over 10 minutes
July 2023
In gestational diabetes, when should insulin be given immediately?
If the fasting blood glucose is over 7.0 mol/L, then insulin should be offered immediately.
July 2023
Grey/white vaginal discharge + Microscopy image shows vaginal epithelial cells studded with adherent coccobacilli + raised vaginal pH (normal range is 3.8 - 4.2). Diagnosis and treatment?
Bacterial vaginosis
Treatment is with either topical or oral metronidazole.
July 2023
What is the treatment priority in adrenal crisis?
The first priority in an acute presentation of adrenal insufficiency should be to ensure the patient is adequately hydrated and this patient has already been appropriate prescribed IV 0.9% sodium chloride for fluid resuscitation.
Following this he should be treated with a corticosteroid - typically hydrocortisone 100 - 200mg either IM or IV.
July 2023
What are the treatment options for AD?
Acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) are recommended as options for the management of mild to moderate AD.
Memantine monotherapy is recommended only for those who are intolerant to acetylcholinesterase inhibitors or who have severe AD
Lorazepam, risperidone and olanzapine may be used to manage the psychological and behavioural symptoms of dementia in specific cases but should only be prescribed by a specialist.
Asthma exacerbation - given short-acting beta2-agonist (salbutamol), an intravenous corticosteroid (hydrocortisone 100mg) and an anti-muscarinic (ipratropium) but not improving. What is the next step?
trial giving magnesium sulfate 2g IV.
However, the most important point is to consider the need for intubation early and to escalate to the senior medical team and intensive care team so that this can be facilitated without a delay if required.
Patient with evidence of refeeding syndrome. What is the most appropriate initial drug to prescribe?
The most important abnormality to correct in this case is the phosphate. This is best done via an IV infusion.
July 2023
What does an elevated PaCO2 and HCO3 with a normal pH
chronic CO2 retention and compensated hypercapnic respiratory failure (type 2 respiratory failure)
For a patient that is a chronic CO2 retention and has compensated hypercapnic respiratory failure (type 2 respiratory failure), but is currently hypoxic, how should oxygen be given?
Sp02 84%, Pa02 7.9 kPa
Their inspired oxygen (Fi02) therefore needs to be carefully increased to address their hypoxaemia as a priority. The most appropriate way to do this is via a Venturi mask which consistently delivers an FiOz of 28% whilst reducing the risk of inducing respiratory acidosis.
The patient’s SpO2 and clinical condition should then be monitored closely and the Fiz increased further (to a 35% Venturi mask) should the target of 88-92% not be achieved. Once target saturations have been reached, an arterial blood gas should be performed to ensure that the higher FiOz has not caused a respiratory acidosis. If it has, the FiOz should not be turned down, as it is required to prevent hypoxaemia. Rather, other steps need to be considered to treat the respiratory acidosis (optimising medical management or NIV)
February 2023
Best method for monitoring asthma control?
Spirometry
NICE CKS advises to monitor asthma control at each review in adults, young people and children aged 5 and overusing either spirometry or peak flow variability testing (twice daily peak flow monitoring). Therefore the correct answer is spirometry as a single peak flow measurement would not be sufficient. The other components of an asthma review can be found within the NICE guidance linked below and form an integral component of the management of asthma.
February 2023
Drug of choice for severe AD?
Memantine
Februrary 2023
How is menorrhagia managed?
NICE CKS recommends a hormonal levonorgestrel intrauterine system (LNG-IUS) as the first-line treatment (e.g. Mirena). If this is declined or unsuitable, tranexamic acid or a non-steroidal antiinflammatory drug (NSAID) is recommended.
February 2023
Under which circumstances should HRT be stopped?
A 2-year-old girl is brought by ambulance to the emergency department with a fever, sore throat and difficulty in breathing. PMH. Normal birth and development. No vaccinations. Temperature 38.9°C, HR 170/min, BP 90/61 mmHg, RR 44/min, 02 sat 92% breathing air. Loud inspiratory stridor is heard. She is drooling significantly. She has increased work of breathing. Weight 12 kg.
Likely diagnosis?
There is a high clinical suspicion of Epiglottitis in an unvaccinated child with stridor, drooling and respiratory compromise.
February 2023
First line management for epiglottitis in a child?
NICE guidelines state that antibiotic therapy for Epiglottitis is Cefotaxime or Ceftriaxone as first line. If there is a history of immediate hypersensitivity to penicillins or cephalosporins,
Chloramphenicol is a suitable second line option.
Cefotaxime dose is 50mg/kg every 8-12 hours
Ceftriaxone dosage is 50-80 mg/kg once daily, doses at the higher end of the recommended range used in severe cases; maximum 4 g per day.
Oral options would not be suitable in this child due to the acuity and airway obstruction.
March 2023
Follow up of pregnant women treated for a UTI without haematuria?
Review choice of antibiotic when results are available.
Change the antibiotic according to susceptibility results if bacteria are resistant - use narrow-spectrum antibiotics if possible and seek specialist advice if unsure.
Send urine for culture once treatment is completed to ensure clearance of infection.
Correct answer - Repeat urine culture only once treatment complete even if symptoms resolve to ensure clearance of infection.
March 2023
Management of primary dysmenorrhoea (that is, menstrual pain in the absence of any identifiable underlying pelvic pathology)?
Offer a nonsteroidal anti-inflammatory drug (NSAID), unless contraindicated.
Options include ibuprofen, naproxen, mefenamic acid, flurbiprofen, or tiaprofenic acid.
Offer paracetamol if NSAIDs are contraindicated or not tolerated, or in addition to an NSAID if the response is insufficient.
If the woman does not wish to conceive, consider prescribing a 3-6 month trial of a hormonal contraceptive as an alternative first-line treatment.
If the response to individual treatments is insufficient, a combination of an NSAID (or paracetamol) and hormonal contraception may be considered.
Consider recommending the following non-drug measures (in addition to drug treatments) to help reduce pain:
Local application of heat (for example, a hot water bottle or heat patch).
* Transcutaneous electrical nerve stimulation (TENS) — set to a high frequency.
* Provide patient information on dysmenorrhoea.
* If symptoms are severe and do not responded to initial treatment within 3-6 months, or if there is doubt about the diagnosis, refer to a gynaecologist.
March 2023
Adverse reaction for the MMR vaccine to tell patient about?
A common side effect of the MMR vaccine is a fever or rash, which typically occurs a week after the vaccination.
Parotid swelling occurs in around 1% children, but usually around the 3rd week. Febrile seizures can occur rarely following the first dose of the MMR vaccine, but usually around days 6-11 after the vaccine. Idiopathic thrombocytopenic purpura (ITP) is a rare side effect, which usually occurs within 6 weeks of the first dose. Adverse effects are much more common after the first dose of the MMR vaccine, rather than the second.
March 2023
Management options for nausea and vomiting in pregnancy?
March 2023
If a patient is on 240mg of codeine, how much morphone can they be given?
24mg
Oral morphine is prescribed at 1/10.
This total dose is then divided up depending on whether the immediate-release (4-hourly dosing) into or moderate-release preparation (12-hourly dosing) is prescribed. Additional doses for breakthrough pain should also be prescribed to sue as required.
March 2023
What is the most appropriate initial topical steroid for eczema flares?
Hydrocortisone 1% cream/ointment
Prescribe generous amounts of emollients, and advise frequent and liberal use.
Consider prescribing a mild topical corticosteroid (such as hydrocortisone 1% for areas of red skin. Treatment should be continued for 48 hours after the flare has been controlled.
Why should ramipril be stopped in suspected lithium toxicity?
Lithium excretion is significantly reduced by ACE inhibitors.
Check if patient has a NEW diagnosis of HTN, indicating that ramipril was recently started.
March 2023
How should women with previous VTE be managed in pregnancy?
Give LMWH e.g. enoxaparin
Women with previous VTE (except those with a single previous VTE related to major surgery and no other risk factors) should be offered thromboprophylaxis with LMWH throughout the antenatal period. Women with previous VTE should be offered pre-pregnancy counselling and a prospective management plan for thromboprophylaxis in pregnancy made. Those who become pregnant before receiving such counselling should be referred at the earliest opportunity in pregnancy to a clinician with expertise in thrombosis in pregnancy.
March 2023
First line treatment for threadworm?
Mebendazole 100 mg oral once only
January 2023
First line antibiotic for otitis media if penicillin allergy?
Clarithromycin 62.5 mg oral twice a day
Erythromycin 125 mg oral four times a day
Management of child with severe asthma attack?
urgent transfer to hospital, B2 agonists and early steroids.
What drug should be withheld while on a course of macrolide antibiotics?
STATINS
nocturnal pain in her upper arms and thighs with morning stiffness in her hips and shoulders for the last 3 weeks + raised ESR
This woman’s acute history and raised ESR is supportive of a diagnosis of polymyalgia rheumatica. The first line treatment of polymyalgia rheumatica is with prednisolone 15mg PO OD.
Patients should be reviewed after one week to assess the clinical response and, if improving, the dose can be reduced slowly after 3 to 4 weeks.
Why should codeine be avoided in breastfeeding?
Codeine should be avoided in breastfeeding as it carries a risk of breathing difficulties in the infant./
January 2023
What are the two forms of emergency contraction (hormonal)?
Ulipristal Acetate (EllaOne) should be considered as the first-line hormonal emergency contraception for a woman who has had unprotected intercourse in the last 120 hours.
Levonorgestrel is effective if taken within 72 hours of unprotected intercourse and may also be used between 72-96 hours [unlicensed use], however its efficacy decreases with time.
December 2022
Outline lithium monitoring
Lithium levels are normally measured one week after starting treatment, one week after every dose change, and weekly until the levels are stable. Once levels are stable, levels are usually measured every 3 months. Lithium levels should be checked 12 hours post dose. TFTs, U&Es, calcium and weight need to be measured every 6 months.
December 2022
What can be used to treat vaginal candidasis?
December 2022
Guidelines for paediatric DKA state that all patients who are not shocked should first receive 10ml/kg 0.9% sodium chloride bolus over how long?
30 minutes
December 2022
What is the maximum dose of lidocaine?
The maximum allowable dose of Lidocaine based on weight is 4.5 mg/kg.
December 2022
Patient had hysterectomy. Watchs transdermal HRT. What are the options?
What are the treatment options for urticaria (e.g. secondary to food allergy)?
Cetirizine hydrochloride
Loratadine
How does phenytoin affect the COCP?
Phenytoin is likely to have reduced the efficacy of her oral contraceptive pill.
Liver enzyme inducing medication can reduce the efficacy of combined oral contraception pills (COCP). Medications which induce liver enzymes include: rifampicin, rifabutin, griseofulvin, carbamazepine, phenytoin, and St John’s Wort, amongst others. Women who take any of these medications should be on an alternative form of contraception. It should be noted that levothyroxine does reduce the efficacy of the COCP, but the COCP can increase need for thyroid hormones. NICE CKS recommends if taken together, to monitor thyroid function and adjust the dose of levothyroxine accordingly.
Side effect of latanoprost eye drops?
The iris of the treated eye may change colour
As the patient has moderate primary open angle glaucoma treatment is necessary to prevent further progression of the condition and preserve vision as much as possible. First line treatments are either prostaglandin analogues (such as Latanoprost) or beta-blockers (such as Timolol). Before initiating treatment, patients should be warned of a possible change in eye colour as an increase in the brown pigment in the iris can occur, which may be permanent; particular care is required in those with mixed coloured irides and those receiving treatment to one eye only. Changes in eyelashes and vellus hair can also occur, and patients should also be advised to avoid repeated contact of the eye drop solution with skin as this can lead to hair growth or skin pigmentation. Treatment is not always necessary - in mild primary open angle glaucoma patients can be regularly monitored by an optometrist and referred for treatment when deemed necessary. Lifetime monitoring is required once treatment is commenced.
Obesity drug to help lose weight?
Orlistat 120 mg oral once a day
Outline olanzapine monitoring
This question is about monitoring of antipsychotic drugs. According to the BNF: “It is advisable to monitor prolactin concentration at the start of therapy, at 6 months, and then yearly.” Other monitoring tests required include Weight, BMI, blood pressure, U&E, LFTs, glucose, HbA1C, FBC, TFTs, lipids & ECG. A baseline Chest X Ray, Creatinine Kinase, Echocardiogram, or vitamin D are not required for monitoring antipsychotic drugs.
Management of prostatitis?
PR: warm, tender prostate.
Monitoring of HRT benefit?
Clinical review should be carried out after a 3 month trial to achieve maximum effect from HRT.
HRT does not require blood monitoring as the aim of treatment is the alleviation of symptoms.
What are the treatment options for a fungal skin infection?
NOTE: terbinafine should not be given to children
What are insulin ‘sick day’ rules?
Cellulitis management?
What is the management offss PID?
How should statin therapy be changed in pregnancy?
Statins should be avoided in pregnancy (discontinue 3 months before attempting to conceive) as congenital anomalies have been reported and the decreased synthesis of cholesterol possibly affects fetal development.
