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OSCE > M+M Drugs/ Examinations > Flashcards

M+M Drugs/ Examinations Flashcards

1
Q

Name 5 general side effects of antipyschotics?

A

Weight gain, dizziness, drowsiness, headaches, stomach upset, memory problems, fatigue, motor (parkinsonain etc)

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2
Q

What are the two very serious side effects of antipyschotics?

A

Agranulocytosis - fever, rash, sore throat

Neuroleptic malignant syndrome- Hyperthermia, tachycardia, hypotension, seizures

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3
Q

SSRI’s - How/ how often do you take?

A

Tablet OD

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4
Q

SSRI - Length of tx

A

Stop 6 months after better but taper off

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5
Q

SSRI - Time to working

A

4-6 weeks

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6
Q

SSRI - SE’s to counsel (5)

A

2 weeks (GI disturbance and increased anxiety)
Low sex drive
Dry mouth
Drowsiness

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7
Q

SSRI - Tests and monitoring (1)

A

Review in 2 weeks

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8
Q

SSRI -

Contraindications (2)

A

Suicide risk
Past psych illness
Heart conditions (long-QT)

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9
Q

SSRI - Supplementary advice (2)

A

www.mind.org.uk

Don’t stop abruptly

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10
Q

Methotrexate - How to take (3)

A

Once weekly tablet
(Injection also available)

  • Folic acid on other day
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11
Q

Methotrexate - Length of treatment

A

Long term

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12
Q

Methotrexate - Time to working

A

1 to 3 months

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13
Q

Methotrexate - Tests (details and frequency) - (4)

A

FBC, U+E’s, LFT’s
Baseline
@2weeks til stable
2-3 monthly

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14
Q

Methotrexate - Side effects (3)

A

Alopecia
Headaches
GI Disturbance

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15
Q

Methotrexate - Complications (3)

A

Pulmonary toxicity - SOB
Liver toxicity - Warn about alcohol
Myelosuppresion- Warn about infections (if you do get an infection then stop AB’s)

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16
Q

Methotrexate - Contraindications (3)

A

Immune deficiency
Pregnant/ breast feeding
Hepatic impairment

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17
Q

Methotrexate - Supplementary (3)

A

No NSAIDS, aspirin
Get flu jab annual
Arthritisresearch.org.uk

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18
Q

Lithium - How to take? (2)

A

Tablet, capsule or syrup

OD or BD

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19
Q

Lithium - Length of treatment

A

Long term

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20
Q

Lithium - Time to working

A

1-2 weeks

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21
Q

Lithium - Tests at baseline (4)

A

FBC, U+E, TFT’s, ECG

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22
Q

Lithium - Monitoring (3)

A

Check after 5 days
Then every week till stable for 4 wks
Then every 3 months

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23
Q

Lithium - Side effects (4)

A

GI (abdo pain/ nausea)
Metallic taste
Fine tremor
Water symptoms (thirst, polyuria, oedema)

(plus lithium toxicity)

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24
Q

Lithium - Complications to warn about (3)

A

Lithium toxicity (GI symptoms, ataxia, drowsiness)
Renal toxicity
Hypothyroidism

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25
Q

Lithium - Contraindications (4)

A

Pregnancy/ breastfeeding
Problems with heart
Problems with kidneys
Problems with thyroid

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26
Q

Lithium - Supplementary (1)

A

www.bipolaruk.org.uk

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27
Q

Atypical anti-psychotics - Mechanism for patients

A

Schizophrenia causes over-activity of chemicals which transmit messages in the brain

Medication helps block some of these messages

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28
Q

Atypical anti-psychotics - How to take

A

Tablet OD or depot injection (weekly)

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29
Q

Atypical anti-psychotics - Length of treatment

A

Quite a while, we want you to be stable and keep you there

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30
Q

Atypical anti-psychotics - Time to working

A

Immediately but may not feel full effects for a few days to weeks

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31
Q

Atypical anti-psychotics - tests

A

Occasional LFT’s

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32
Q

Atypical anti-psychotics - Important side effects (3)

A

Weight gain
Movement problems
Drowsiness

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33
Q

Atypical anti-psychotics - complications (2)

A

Neuroleptic malignant syndrome (fever and stiff muscles)

Agranulocytosis (sore throat, rash, infection)

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34
Q

Atypical anti-psychotics - contraindications (2)

A

Liver failure

Pregnancy (caution- risk benefit)

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35
Q

Levodopa - Mechanism for patients

A

Works to replace dopamine in your brain

As bits of your brain have stopped making it in PD

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36
Q

Levodopa - How to take

A

Tablet 3-4x daily with food

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37
Q

Levodopa - Length of treatment

A

For as long as keeps working, after 5 years most see end dose deterioration

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38
Q

Levodopa - Time to working

A

Immediately but a few days to a few weeks to see full effects

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39
Q

Levodopa - Tests

A

None

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40
Q

Levodopa - Important SE’s (3)

A

Psychosis and mania
N+V
Movements you can’t stop (dyskinesias)

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41
Q

Levodopa - Complications (1)

A

End dose deterioration and on off effects

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42
Q

Levodopa - Supplementary info

A

www.parkinsons.org.uk

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43
Q

Bisphosphonates - Mechanism

A

Stops your body breaking bone down and helps it to build bone back up

44
Q

Bisphosphonates - Supplementary advice

A

Exercise, stopping smoking and eating a good diet are all just as important

45
Q

Bisphosphonates - How to take (4)

A

Either weekly tablet or smaller dose daily
With full glass of water

At least 30 mins before food and stay upright for at least 30 mins

46
Q

Bisphosphonates - Length of treatment

A

Long term

47
Q

Bisphosphonates - Baseline tests (1)

A

Dental checkup (risk of osteonecrosis of jaw)

48
Q

Bisphosphonates - Important SE’s (3)

A

Headache
Heartburn, bloating or indigestion
GI upset (diarrhoea)

49
Q

Bisphosphonates - Complications (1)

A

Osteonecrosis of jaw

50
Q

Bisphosphonates - Contraindications (3)

A

Pregnancy
Dysphagia
Stomach ulcers

51
Q

Diazepam - Contraindications (3)

A

Respiratory depression
Neuromuscular weakness
Pulmonary insufficiency
Pyschosis

52
Q

Diazepam - Indications (5)

A 
Muscle spasms
Anxiety 
Agitation 
Insomnia 
Panic attacks 
Alcohol withdrawal
53
Q

Diazepam - How to take?

A

Oral tablet TDS

Or IM injection

54
Q

Diazepam - Time to working?

A

Immediate

55
Q

Diazepam - Tests?

A

None

56
Q

Diazepam - Important SE’s (3)

A

Drowsiness
Confusion
Lightheadedness

57
Q

Diazepam - Complications (2)

A 
Muscular weakness (SOB)
Dependence
58
Q

Steroids - What are they?

A

Steroids naturally occur in your body and help your dampen down your immune system. When we give you steroid tablets we’re just giving you more of what your body already has to help it fight your immune system.
Note they are not the same as the steroids body builders use

59
Q

Steroids - How long to take for and chance of side effects?

A

Short course <2weeks = Unlikely SE’s

Long course >2weeks = Possible SE’s

60
Q

Steroids - Side effects (9)

A 
1- Weight gain (via appetite increase)
2- Increased risk of infection (look out for it)
3- Increase risk diabetes
4- Increase blood pressure
5- Hair thinning
6- Skin thinning, bruising, poor healing, stretch marks 
7- Mood and behaviour changes
8- Stomach ulcers (give with PPI)
9- Osteoporosis
61
Q

Steroids - How to stop

A

Don’t stop suddenly if been taking for more than 3 weeks

62
Q

Steroids - Symptoms of withdrawal (3)

A

Weak and tired
Nausea and vomiting
Abdo pain and diarrhoea

63
Q

Name the 9 steps of a parkison examination

A

1) General inspection - Walking aids etc
2) Gait - Stooped, shuffling, festinating, reduced arm swing
- Pull test
FACE
3) Glabellar tap
4) Speech
5) Poverty of expression
ARMS
6) Tremor exam (rest, action should improve) - distract
7) Akinesia (thumb to fingers, play piano)
8) Tone and rigidity
FUNCTION
9) Write, handle coins

64
Q

Name the framework of an Ank Spond examination

A

(Normal spine plus plantar fascitis, Achilles tendonitis, shoulder and hip for peripheral arthritis)

65
Q

What are the components of spine exam? (6) - Specific detail for Feel and Special tests

A

General inspection
Gait
Look
Feel (paraspinal muscles, vertebral bodies, SI joints)
Move
Special tests (Back against wall - AS, schobers, straight leg raise, femoral nerve stretch)

66
Q

What are the components of an opthalmoscope examination? (9)

A 
1- General inspect (glasses, scars, discharge, swelling, redness)
2- Lighting comment
3- Red reflex
4- Warn closeness
5- Disc (nasal, CCC)
6- Quadrants 
7- Look into light (Macula)
8- Repeat other eye
9- Summary (neuro exam, testing VA, fields, movements, reflexes)
67
Q

Name fundoscopy examination findings in diabetic eye disease (4)?

A

Dot and blot haemorrhages
Cotton wool spots
Hard exudates
Microaneuryms

68
Q

Name fundoscopy examination findings in Glaucoma? (1)

A

Large cup

69
Q

Name fundoscopy examination findings in Papilloedema? (1)

A

Lost contour of disc

70
Q

Name fundoscopy examination findings in Central Retinal Venous Oclusion? (2)

A

Haemorrhage and exudates

71
Q

Name fundoscopy examination findings in Central Retinal Artery Oclusion? (1)

A

Cherry red spot

72
Q

Name fundoscopy examination findings in AMD? (1)

A

Drusen deposits

73
Q

What should be check in an examination of CNII?

A 
3 Acuity (Snellen, colour, near)
3 Reflexes (D/C, RAPD, accomodation)
3 Fields (Gross, finger test, blind spot)
1 Opthalmoscopy
74
Q

What should be tested for CN3/4/6?

A

Draw H with red pin

Accomodation

75
Q

What is seen in a R trochlear nerve palsy?

A

On left gaze the right eye will be too far up (as superior oblique failed)

76
Q

What is seen in a L occulomotor nerve palsy?

A

L eye points down and out, can’t adduct L eye

77
Q

What is the function the inferior oblique muscle?

A

Elevates eye and turns laterally

78
Q

What is the function of the superior oblique muscle?

A

Depresses eye and turns eye laterally

79
Q

What components of the trigeminal nerve should be tested?(5)

A 
Fine sensation (3 branches)
Offer pinpick sensation
Muscles of mastication 
Offer jaw jerk reflex
Offer corneal reflex
80
Q

What are the components of a test of CN8?

A

Whisper test
Rinne’s
Weber’s
Romberg

81
Q

In a hand examination which nerve is being tested with wrist and finger extension?

A

Radial nerve

82
Q

In a hand examination in little finger abduction?

A

Ulnar nerve

83
Q

In a hand examination thumb abduction?

A

Median nerve

84
Q

What are the components of a hip exam? Specific any that are specific to hip in more detail?

A

1) Intro - Pain/ hip replacement
2) Inspection (include footwear)
3) Gait
4) Look (include Trendelenburg and leg length)
5) Feel (temp, trochanter)
6) Move (flex, extend, rotate I/E, ab/aduct)
7) Special (Thomas’)

85
Q

What are the components of a knee exam?

A 
Intro 
Gen inspection
Gait
Look
Feel 
Move
Special (ACL/ PCL/ MCL/ LCL/ McMurray)
86
Q

Give two CI to Carbamazepine (pharma)?

A

Warfarin

COCP

87
Q

What things should be assessed on the feel component of a hand exam? (6)

A 
Temperature
Thenar/ hypothenar
Duputrens 
Sensation 
Anatomical snuffbox
Wrists and all joints
88
Q

Name the special tests for a shoulder examination? (6)

A 
Supraspinatus 
Teres minor/ infraspinatus 
Subscapularis 
Instability 
Scarf test 
Hawkings test (impingement)
89
Q

What power tests should be done in a hand exam? - Include functional (6)

A 
Wrist and finger extension (radial)
Abduct little finger (ulnar)
Abduct thumb (median) 
Power grip
Ok sign pincer

Pick up coin (function)

90
Q

What should ALWAYS be counselled on in a drug explanation station?

A

Allergies

91
Q

What is the apparent leg length, where is it measure from?

A

Measured from xiphisternum or medial malleolus

92
Q

What does a discrepancy in the apparent leg length suggest?

A

Spinal or pelvic deformity (for example scoliosis)

93
Q

What does a discrepancy in the true leg length suggest?

A

Shortening of the limb (deformity or fracture)

94
Q

What is the true leg length, where is it measure from?

A

ASIS to medial malleolus

95
Q

Name 4 differentials for elbow pain?

A

Olecranon bursitis > Localised swelling over olecranon
Lateral epicondlyitis (Tennis)
Medial epicondylitis (Golfers)
Cubital tunnel syndrome (Ulnar nerve entrapment)

96
Q

What are the components of an elbow exam? Give at least one sub-component of each (5)

A

Intro (include pain)
Look (include carrying angle)
Feel (include olecranon, temprature, biceps tendon)
Move (flex, extend, pronate, supinate)
Special tests (hands pronated)
- LE: Wrists up (extend) whilst palpating LE - Tennis
- ME: Wrists down (flex) whilst palpating ME - Golf

97
Q

What are the steps of a cerebellar exam (and specific sub components)? (6)

A

Inspection
Gait - ataxic, tightrope walking
Romberg - Sensory ataxia (not cerebellar)
Face- Nystagmus, saccades, speech (+lengthy)
Arms - Tone, finger nose, arms up and cerebellar rebound, dydiadochokinesia
Legs - Coordination

Full neuro exam and exclude Parkinson’s etc.

98
Q

What investigations would you do for suspected CES?

A 
LL Neuro
Spinal exam (disc prolapse)
Abdominal exam (bladder)
PR exam (sphincter tone)
99
Q

Where to motor neurons deccusate?

A

Medulla

100
Q

Where do the dorsal columns deccusate?

A

Brainstem

101
Q

What information is carried by the dorsal columns?

A

Fine touch and proprioception

102
Q

What information is carried by the spinothalamic tracts?

A

Pain and temperature

103
Q

Where do the spinothalamic tracts deccusate?

A

Level of exit

104
Q

What are the components of a balance examination?

A 
General inspection 
Gait - including heel/toe
Rombergs and unterbergers test
Cerebellar exam (DANISH)
Proprioception and lower limb sensation 
Offer dix-hallpike
105
Q

What are the components of a tremor exam?

A 
General inspection (rest tremor)
Gait (Parkinsonian or Ataxic) 
Tremor (action, intention) 
Distract to exagerate 
Hyperthyroid (quick feel of neck)

OSCE (6 decks)

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