Medicine Flashcards by Evelyne Kiu

What is the 2nd line medication to treat IBS after antispasmodics/loperamide?

TCAs e.g. AMT for analgesic effect

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When to do stool microscopy for diarrhoea (child)?

after 7 days

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What eGFR to use metformin
a) with caution
b) STOP altogether

a) 45
b)30 - STOP

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For GAD - how long to continue medication (SSRI) for?
For Panic disorder - how long?
Depression - how long?

12 months once established - due to risk of relapse
6 months
6 months

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what is buproprion used for? how does it help? contraindications?

for smoking cessation
reduce craving
not in eating disorders, bipolar, pregnancy, hx of seizures

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what is disulfiram used for?how does it help? contraindications?

promotes abstinence from alcohol - makes you feel like shit if you drink alcohol (cause severe rxn)
inhibit acetyldehyde dehydrogenase
not in cardiac failure, coronary artery disease, history of cerebrovascular accident (CVA), hypertension, psychosis and suicide risk.

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what is acamprosate used for? how does it help? contraindications?

reduces craving, a weak antagonist of NMDA receptors
not in renal iimpairment, severe hepatic impairment

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Features of suspected malignancy in a lump?

malignancy in a lump include
size more than 5 cm
increasing in size and deep to the fascia
pain

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What are the 1st and 2nd line medications for GAD?

SSRI
another SSRI/ Venlafaxine (SNRI)
pregabalin

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What are the 1st, 2nd, 3rd line tx for GAD?
What are the 1st and 2nd line medications for panic disorder?

GAD:
1. SSRI
2. another SSRI/SNRI
3. pregabalin

Panic disorder
1. SSRI
2. TCA - imipramine, clomipramine

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how to treat h pylori

PPI + amox + clari or metronidazole
if pen allergic
PPI + clari + metronidazole

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in management of angina, what medication should not be prescribed together with a BB?

verapamil - risk of complete heart block
Also don’t Rx verapamil in HF

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Mx of angina: first 4 steps
What other preventative meds to add?

BB or CCB based on person/comorbidities
then monotherapy up to maximum dose
add the other med
add other meds e.g. long acting nitrate etc.
then consider Pci/cabg

add statin & aspirin for preventative

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Mx of heart failure (HFREF)

ACEi+BB
Aldosterone antagonist e.g. spironolactone/eplerenone
+?SGLT2i
3rd line: initiated by specialist

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features of WPW syndrome on ECG?

Wave - Delta wave
PR - short
Wide - QRS
(narrow complex tachy)

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Where might you expect ST changes for a posterior MI? and what sort of ST changes?

anterolateral leads (V1-3)
ST depression

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what BP med is contraindicated in mod-severe aortic stenosis?

ACEi

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for management of a pt w HTN and diabetes, which meds should not be used in combination? why?

Thiazide & BB
The routine use of beta-blockers in uncomplicated hypertension should be avoided, particularly when given in combination with thiazides, as they may cause insulin resistance, impair insulin secretion and alter the autonomic response to hypoglycaemia.

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Poorly controlled HTN - already taking max dose ACEi and CCB. Next step? (step 3 in HTN algorithm)

Add thiazide-like diuretic e.g. indapamide.

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What to Rx to treat gut oedema for pt with HF?

bumetanide - better bioavail than furosemide

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Post splenectomy, what prophylactic abx to use?

Pen V 1st line for at least 2 yrs

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What does the anaemic picture look like for pt with haemoglobinopathy?

anaemia is normocytic with a low or normal ferritin level

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Important adverse effect of taking carbimazole?

agranulocytosis - fever, sore throat, mouth ulcers

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what cancers are likely to spread to bone?

breast, thyroid, bowel, kidney, prostate and myeloma

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A 68-year-old man is treated for a proven urinary tract infection. He has an enlarged prostate on examination. According to the National Institute for Health and Care Excellence (NICE) guidelines, which is the MINIMUM wait, if any, before his prostate-specific antigen (PSA) should be measured?

6 weeks

A 61-year-old patient presents with dysuria, urinary urgency and frequency with perineal pain radiating to the rectum and tip of the penis. Urine dipstick test is positive for nitrites and leucocytes.

acute bacterial prostatitis

BP control in CKD: ACR<30 - what antihypertensive to Rx? if ACR>30?

follow normal HTN guidelines if ACR>30, ACEi/ARB first

What is the target Hba1c for T1DM patients?

Parameters for impaired glucose tolerance - fasting & 2hr?

6.1-7 7.8-11.1

Urine ACR result to diagnose microalbumiuria?

What value is fasting glucose for a diagnosis of prediabetes?

6.1-6.9

loop diuretic e.g. bumetanide, furosemide - effect on potassium

drop

ramipril - effect on potassium

increase

thiazide-like diuretic - effect on potassium

drop

spironolactone - effect on potassium

increase

Simon Broome criteria for FH - TC & LDL-C?

TC >7.5 LDL-C>4.9

What are DAST-A and CRAFFT tools used for?

substance misuse in adolescents

Which schedule of drugs are CDs? List out Schedules 1-5 and what drugs are in each category

CDs = schedule 2,3 1: cannabis, LSD. no medicinal value 2: diamorphine, morphine, cocaine, pethidine, amphetamine 3: midazolam, temazepam, barbiturates, pregabalin, gabapentin, buprenorphine 4: 1. benzos (except midaz/temaz), zopiclone, zolpidem 2. hcg, somatotropin, androgenic/anabolic steroids 5: oramorph, codeine

ABX for severe campylobacter?

clarithromycin

Tx & duration for severe oesophagitis on endoscopy?

8/52 of standard dose PPI if no help then HIGH dose PPI or switch to another PPI standard/high dose

indications for FIT testing & age categories

>40, abdo pain + weight loss <50, rectal bleed + abdo pain/weight loss >50, rectal bleed/abdo pain/weight loss >60 anaemia, with or without iron deficiency

1st, 2nd, 3rd line tx for C diff

vancomycin fidoxamicin iv vancomycin + metronidazole

How to monitor haemachromatosis Mx/venepuncture (what to measure & target)

aim ferritin <50 transferrin sat <50%

Ferritin, iron, transferrin sat, TIBC, transferrin for: IDA haemachromatosis?

IDA: low ferritin, iron, transferrin sat; raised TIBC, raised transferrin haemachromatosis: raised ferritin, iron, transferrin sat; low TIBC, transferrin

Tx of acute asthma exacerbation - prednisolone dosage for children

<2 y/o - 10mg 2-5 y/o - 20mg >5 y/o - 30-40mg

Tx for Lyme disease?

Doxycycline 200mg, 21 days Sun protection when taking doxy amoxicillin, doxycycline for 21 days or azithromycin for 17 days.

how often to check TSH in thyroid disease - initially and once stable?

6 weeks initially 3 months once stable

what is the threshold for normal FIT? (when to refer)

>10 mcg/hb g

what is the definition of young carers?

< age 18

urate level for gout dx?

>360 if <360 during a flare, repeat in 2 weeks once flare settled

when to do ambulatory BP if found to have high clinic BP?

ambulatory blood pressure assessment if clinic readings are between 140/90 mmHg and 180/120 mmHg prior to commencing antihypertensive treatment.

Define osteopenia & osteoporosis in terms of Dexa scan results

>-1 is normal Osteopenia: T -1.5 to -2.5 Osteoporosis: T <-2.5

How much of her initial body weight should she have lost to in order to continue treatment with orlistat?

5% in 3 months More lenient if T2DM

warfarin - mx of high inr inr 5-8, no bleed inr 5-8, minor bleed inor >8, no bleed inr >8, minor bleed major bleed

withhold warfarin, reduce maintenance dose 1-3mg iv vit K, stop warfarin, restart when inr <5 1-5mg po vit P IV version, stop warfarin, restart when inr <5, repeat in 24hr if still too high 1-3mg IV vit K, stop warfarin, restart when inr <5, repeat in 24hr if still too high 5mg IV vit K, stop warfarin, prothrombin complex or ffp

guidelines for starting orlistat

bmi >=28 + associated RF bmi >=30

EoLC: convert 24hr dose po morphine to sc diamorphine

divide by 3

EoLC: convert 24hr po morphine to po oxycodone

divide by 1.5-2

EoLC: convert po codeine/tramadol to po morphine

divide by 10

EoLC: sc oxycodone to sc diamorphine

divide by 1.5

abx for chronic prostatitis (sx <6 months) and for how long?

trimethoprim or doxycycline 4-6 weeks

Male STI treatment? if epididymo-orchitis?

intramuscular ceftriaxone 1g as a single dose, plus doxycycline 100 mg orally twice daily for 10–14 day epididymo-orchitis: ofloxacin 200 mg orally twice daily for 14 days, or levofloxacin 500 mg orally once daily for 10

Tx for prostatitis

ofloxacin or ciprofloxacin for 14 days

what factors make up the MELD score for liver cirrhosis?

bilirubin albumin PT encephalopathy ascites

what are the criteria in Glasgow 7 point checklist for malignant melanoma?

major: change in size irregular shape irregular colour minor: >7mm diameter oozing inflammation change in sensation

What timescale to NOT use PPI/abx before c-urea breath test for h pylori?

Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks

Which is the SINGLE MOST likely vitamin deficiency associated with coeliac disease?

Vit D

minimum length of abx treatment for non CF bronchiectasis?

7 days (7-14)

List SE of amiodarone

corneal deposits, optic neuropathy slate grey thyroid dysfunction pulmonary deposits liver fibrosis increase QT interval, brady cardia skin rash - phytotoxic peripheral neuropathy effects may be delayed

define uncontrolled asthma

any exacerbation needing po steroid waking up in night >1/week frequent reg sx e.g. needing reliever inhaler >3 days/week

how much to allow eGFR to drop by when starting ACEi?

eGFR can drop by 25% from baseline or Cr can increase by up to 30%

what are the criteria in ORBIT score?

Older age >75 Reduced Hb (can score 2) Bleeding (2) Insufficient renal fx Treatment w antiplatelet 3 = medium 4-7 = high

AAA screening & what to do for each category

<3 - normal 3-4.4 - annual scan 4.5-5.4 - 3 monthly scan >5.5 - refer within 2/52

Tx for OCD mild/mod/severe what scale to use?

scale: YBOCS mild: CBT (ERT) mod: SSRI TCA - clomipramine severe: refer sec care to assess

hypothyroidism, goitre and anti-TPO, dx?

hashimoto's thyroiditis

treatment for impetigo?

hydrogen peroxide then if top abx: fusidic acid mupirocin if resistance to fusidic