Long term conditions

Question 1

Give a drug type that should be given alongside Levodopa for parkinsons

Answer 1

Periferal decarboxylase inhibitor eg. carbidopa, benserazide (note: may be combination formulas such as co-caryldopa or co-benyldopa)

Question 2

Give 2 drug classes and examples of drug names for drugs used to delay use of levodopa

Answer 2

Dopamine agonists (Bromocryptine, carbogaline, pergolide)
MAO B inhibitors (selegiline, rasagiline)

Question 3

Give 3 differences between parkinsons tremor and benigh essential tremor

Answer 3

Parkinsons is asymetrical, essential is symetrical
Parkinsons is worse at rest, better w voluntary movement. vice vera for essential
Parkinsons is 4-6hz, essential is 5-8hz

Question 4

What are the three most common autiantibodies found in primary sclerosing cholangitis (in order, most to least common)

Answer 4

Antineutrophil cytoplamic antibody (ANCA)
Antinuclear antibody (ANA)
Anticardiolipin antibody (aCL)

Question 5

What autoantibody is found in primary biliary cirrhosis (part of diagnostic criteria)

Answer 5

Antimitochondrial antibody (AMA)

Question 6

What drug class if first line in inducing remission in crohns?

Answer 6

Corticosteroids

Question 7

What 2 drugs may be offered first line (one or the other) for maintaining remission in crohns?

Answer 7

Azathioprene

Mercaptopurine

Question 8

Give 6 extra intestinal features of inflammatory bowel disease

Answer 8

Arthritis
Erthema Nodosum
Uveitis (in UC)
Primary sclerosing cholangitis (in UC)
Oesteoporosis

Question 9

What two drugs are given as maintainence therapy for addison’s disease?

Answer 9

Hydrocortisone (replaces cortisol)

Fludrocortisone (replaces aldosterone)

Question 10

Give two classic symptoms of interstitial lung disease, one examination finding and three investigations

Answer 10

Progressive SOB
Dry cough

Bilateral fine inspiratory crackles

CXR
High resolution CT scan (gold standard)
Lung function tests (spirometry and gas transfer)
-

Question 11

Give three drugs that may cause interstital lung disease

Answer 11

Amiodarone
Nitrofuratoin
Methotrexate

Question 12

Give four causes of interstitial lung disease affecting upper lobes

Give 6 causes of interstitial lung disease affecting upper lobes

Answer 12

Acronym -> AIDS
Asbestosis
Ideopathic pulmonary fibrosis
Drug induced
Scleroderma (connective tissue disorders

Acronym -> BREASTS
Beryllosis
Radiation
Eosinophilic (hypersensitivity pneumonia)
Ankylosing spondylitis
Sarcoidosis
TB
Sillicosis

Question 13

What is the management for rheumatic fever

Answer 13

NSAIDS

oral penicillin V

Question 14

How does primary hyperaldostroneism present and what are the first and 2nd line investigations?

Answer 14

Presentation:

• HTN
• Hypokalaema

Ix:

1. Plasma aldosterone: renin ratio
2. High res CT-abdomen

Question 15

Give 7 features that neurofibromatosis T1 may show (2 of which needed for clinical diagnosis)
What is the classic feature of neurofibromatosis T2?

Answer 15

CRABING
Cafe-au-lait spots
Relative w NFT1
Axillary freckles
Bony dysplasia
Iris harmatoma (yellow spots)
Neurofibromas (soft lumps on skin)
Glioma of optic nerve

Bilateral acoustic neuromas (benigh)

Question 16

Describe the long term symptomatic treatment of stable angina (medical treatment)?
What 4 alternative drugs may be offered if the 1st line isnt toelrated?

Answer 16

1st line: beta blocker or calcium channel blocker (diltiazem/vermapil if monotherapy. nifedapine if dual therapy (verpamil CI if dual therapy!))
2nd line: combination or switch to other

If Ci or not tolerated, switch either to

• Long acting nitrate
• Nicorandil
• Ranolazine
• Ivabradine