Knowledge revision - Medicine

Question 1

Which investigation is essential after first seizure?

Answer 1

ECG

Question 2

What are the first-line options for gen tonic-clonic epilepsy?

Answer 2

Lamotrigine, valproate (not if woman), carbamazepine

Question 3

What are the first-line options for focal epilepsy?

Answer 3

Lamotrigine or carbamazepine

Question 4

What are the first line options for absence seizures?

Answer 4

Valproate or ethosuximide

Question 5

Which AEDs are enzyme inducers?

Answer 5

Phenytoin, carbamazepine and topiramate

Question 6

Which methods of contraception can be used in women taking enzyme-inducing AEDs?

Answer 6

Mirena IUS/Copper IUD
Barrier methods
NO systemic hormonal contraception - reduced efficacy

Question 7

Which common medications can lower seizure threshold?

Answer 7

Penicillins, quinolones, antipsychotics, chloroquines

Question 8

Which clinical scoring system is used in ACS?

Answer 8

GRACE

Question 9

Which scoring system is used in CAP?

Answer 9

CURB65

Question 10

Which scoring system is used for VTE?

Answer 10

Wells’ score

Question 11

Which scoring system is used to calculate the risk of stroke in AF?

Answer 11

CHADSVASC

Question 12

Which scoring system is used to calculate the risk of stroke in AF?

Answer 12

CHADSVASC

Question 13

Which scoring system is used to calculate bleeding risk in patients on anticoagulation?

Answer 13

HASBLED

Question 14

Which scoring system is used in assessing severity of heart failure?

Answer 14

NYHA

Question 15

Which scoring system predicts prognosis in chronic liver disease?

Answer 15

Child-Pugh score

Question 16

Which scoring tool is used to predict risk of cardiovascular disease?

Answer 16

QRISK

Question 17

Which scoring system is used to assess risk pre-endoscopy in UGIB?

Answer 17

Glasgow-Blatchford

Question 18

Which scoring system is used to assess risk post-intervention in UGIB?

Answer 18

Rockall

Question 19

What does CURB65 stand for?

Answer 19

 Confusion
 Urea > 7
 RR > 30
 BP < 90 / 60
 > 65

Question 20

What symptoms may be present in patients with CKD?

Answer 20

Itching, loss of appetite, oedema, nausea, fatigue

Question 21

Which patients with CKD should be referred to a specialist?

Answer 21

o eGFR < 30 or ACR > 70
o Accelerated progression
o Unable to control BP despite 4 anti-hypertensives

Question 22

What are the cornerstones of management of CKD?

Answer 22

Treat underlying causes
Optimise CVD risk - ACEI and primary prevention with atorvastatin
Treat complications eg. renal anaemia, bone disease etc
ESRD - dialsysis/transplant

Question 23

What is the Hb target in CKD?

Answer 23

100-120

Question 24

What does the renal diet include?

Answer 24

• Often fluid restriction
• Low salt
• Low potassium – no bananas, cooked greens/spinach, oranges
• Low phosphorous – greens/mushrooms, certain cereals, soft drinks like diet coke

Question 25

When should patients with CKD start preparing for the possibility of requiring RRT?

Answer 25

eGFR < 30

Question 26

Which patient group should not receive morphine?

Answer 26

reduced renal function

Question 27

Which analgesics could you consider if pain persisting despite paracetamol?

Answer 27

Weak opioids eg. codeine, DHC, tramadal

Question 28

What is the usual dose of codeine?

Answer 28

30-60mg every 4 hours if req

Question 29

What is the usual dose of Morphine?

Answer 29

10mg up to 4-hourly initially

Question 30

How do you convert from PO to SC Morphine?

Answer 30

Half the dose

Question 31

How is heart failure managed?

Answer 31

o Refer to cardiology o Advice re condition o Medical treatments  ACEI & beta-blocker  Can add aldosterone antagonist  Loop diuretics if severe oedema o Flu, COVID and pneumococcal vaccines

Question 32

Which CXR findings are consistent with CCF?

Answer 32

A - Alveolar oedema (bat wings) B - Kerley B lines (interstitial oedema) C - Cardiomegaly D - Dilated upper lobe vessels E - Effusion (pleural)

Question 33

What initial management can be started in DKA?

Answer 33

IV Fluids and 6 units/h Actrapid

Question 34

What is the most sensitive marker of hepatocellular damage?

Answer 34

ALT

Question 35

What fold increase in ALT suggests hepatocellular damage?

Answer 35

> 10

Question 36

What fold increase in ALP suggests cholestasis?

Answer 36

> 3

Question 37

Give causes of isolated hyperbilirubinaemia.

Answer 37

Gilbert's syndrome/haemolysis

Question 38

ALT > AST suggests...

Answer 38

Chronic LD

Question 39

AST > ALT suggests...

Answer 39

Acute LD

Question 40

What is the first-line treatment for stable angina?

Answer 40

PRN short-acting nitrate + beta-blocker and/or dihydropyridine CCB (Nifedipine, Amlodipine or Felodipine)

Question 41

Give examples of antiemetics that could be prescribed

Answer 41

Cyclizine 50mg PO Prochlorperazine buccal 3mg