Mocks Flashcards
1
Q
Vancomycin should be infused over
A
`100 minutes
2
Q
Some drugs associated with phototoxicity
A
Isotretinoin
Doxycycline
Amiodarone
Tacrolimus
3
Q
Prophylactic iron can be started how soon after birth and at what dose?
A
4-6 weeks
4.5 mg - 9 mg
4
Q
Spironolactone carries a risk of
A
Gynaecomastia (enlargement of mans breasts)
5
Q
How should perindopril be taken?
A
30-60 minutes before food
6
Q
Which ONE of the following statements about Patient Group Directions (PGDs) is
true?
A a PGD applies to treatment by a registered nurse only.
B a PGD applies to treatment of a specific patient on an individual basis by a qualified
prescriber
C a PGD must be signed by the doctor, (or dentist) and pharmacist
D a PGD relates only to the supply of medicines
E prescription only medicines cannot be supplied under a PGD
A
C
7
Q
Do anti Xa levels need to be monitored with DOACS or LMWH?
A
LMWH
8
Q
Which antimalarial carries a risk of hallucinations, depression and psychosis?
A
Mefloquine
9
Q
What is the reversal agent for benzodiazepines?
A
Flumazenil
10
Q
Risk of causing epidural haematoma (collection of blood in between skill and dura mater) has been associated with which anticoagulants?
A
NOACS
11
Q
What is first line in an acute attack of gout when NSAIDs are contraindicated?
A
Colchicine
12
Q
True or false: antipyretics and analgesics should be given routinely before immunisation
A
False
13
Q
When is the largest peak incidence of type 1 diabetes
A
Early adolescence
14
Q
What are the symptoms of the following:
1- Bacterial vaginosis
2- Trichomoniasis vaginalis
3- candida albicanas (thrush)
A
1- Thin, white/clear, fishy smelling discharge (BV)
2- Itchy, lot of discharge that is forthy-smelling and is yellow-green in colour (TV)
3- White cottage-cheese like discharge (thrush)
15
Q
A productive cough with pinky and forthy sputum is one of the characteristics of?
A
Heart failure
16
Q
Antiemetic for premedication short term anxiety
A
Lorazepam
17
Q
Failure to treat which condition could lead to heart failure and why?
A. Anaemia B. Asthma/COPD C. Diabetes D. hepatic/renal disease E. Hypercholestrolsemia
A
A
When anaemia becomes severe the heart has to pump harder and faster to compensate for decreased oxygen levels in body
18
Q
Mrs E is collecting her regular repeat prescription for osteoporosis. You ask how she and the family are and she tells you that several members of the family have been suffering with diarrhoea on and off since their recent trip to Pakistan. What is the cause of diarrhoea?
A
Giardiasis
drinking water contaminated with the Giardia parasite, or through direct contact with an infected person – often contracted abroad, but many people don’t develop the symptoms until they return home.
19
Q
Mrs F wants advice regarding her son aged 11 who is going on a school trip to London. He has had diarrhoea and she is worried that the other school children or his two young siblings may also get it. His diarrhoea started yesterday; he went to the toilet about six times and was sick once, but has not been sick since. He has cramping pains, but is generally well and anxious not to miss his trip. Yesterday he had pie and chips from the local takeaway during his lunch break at school. No one else in the family ate the same food
A
Salmonella
20
Q
Co-fluampicil is not allowed on nhs prescription
A
.
21
Q
External audit
A
involves an assessment which is carried out by a person who is not involved in the process being audited, and is not having their own standards of practice audited within the process
22
Q
Self audit
A
involves an individual practitioner assessing his or her performance against published standards and personal objectives
23
Q
Peer audit
A
involves a group of practitioners, of similar status, considering their own performance against standards decided by the group, usually based on national standards.
24
Q
An increase of what hormone indicates pregnancy
A
hcG
25
Chloramphenicol is caused by which virus
Adenovirus
26
What can be characterised as a vesicular rash, presenting unilaterally over the scalp forehead which extends to eye.
Herpes Zoster
27
What can be characterised as isolated red erythrmatous scaly lesions with defined edges with some that are round and others oval in shape
Tinea corporis
28
What is the antipsychotic of choice to treat aggression in moderate to severe Alzheimer’s?
Risperidone
29
What electrolyte disturbances can occur during prolonged treatment with PPIs?
Hypomagnaesemia
Hyponatraemia
Especially if used with digoxin
30
Safety alert about naltrexone
Risk of disagrees and death from inappropriate doses of naloxone in patients on long term opioid treatment
31
What is an uncommon side effect of nicorandil?
Oral ulceration and intestinal ulceration (rare)
32
Which agent is used to correct blood ph?
Sodium bicarbonate
33
What is the only neuromuscular blockade reversal?
Suggamadex
34
After thyroxine initiation patients should be reviewed how often?
3-4 weeks, dose adjustments can be made.
Once TSH stabilised can be tested annually
8-12 weeks after changing dose
NB dose should be increased by 25/50 mcg in pregnancy
35
Side effects of thyroxine
Hyperthyroidism (over treatment)
Reduced bone mineral density
Worsening of angina
AF
Interacts with iron (give 2 hours apart)
36
When changing oral to sc route morphine, what should the dose be?
Oral morphine to sc morphine : ratio is 1 to 2 or 1 to 3. Normally divide by 2
Oral morphine to sc diamorphine divide by 3
37
In DKA which is the 1st line management?
1. IV fluids
2. IV insulin
3. Correction or hypokalaemia
38
Antiemetic of choice for N&V due to mechanical bowel obstruction?
Cyclizine
39
Antiemetic of choice for metabolic causes of vomiting (eg hypercalcaemia, renal failure) and for opioid induced vomiting?
Haloperidol
40
Antiemetic of choice for N&V after operation or in patients receiving cytotoxics?
Ondansetron
41
Which antiemetic can’t be given via SC route as it can cause skin reactions at injection site?
Prochlorperazine
42
Antiemetic choice for migraine induced N&V
Domperidone or metoclopramide
43
Cluster headache
severe, unilateral pain within and above the eye in the temporal region which lasts for two hours and occurs three times a day. Refer.
44
Which disease presents with fever, loss of appetite, sore throat, raised spots on mouth, throat and skin and feeling unwell. After 12 to 36 hours, the red spots develop into yellowy-red ulcers in your mouth, on your tongue and inside your cheeks. After one to two days, sores may start on hands and feet?
Hand, foot and mouth disease.
seek medical advice if symptoms worsen or do not resolve in 7-10 days.
Drink plenty of fluids. Eat soft foods. Analgesics such as paracetamol or ibuprofen.
45
Angiodeama
Rash all over arms and legs, very itchy, breathlessnes, becoming progressively worse. Allergic reaction as fluid accumulates. (can happen as a result of ACEi)
46
Rotavirus vaccine
Protects against rotavirus infection, a common cause of childhood diarrhoea and sicknesss. It is given at 8 and 12 weeks of age. Rotavirus liquid vaccines are given by mouth (orally) to young infants.
47
Buccastem only indication
N&V in previously diagnosed migraine
48
Antipsychotics and methadone
Increased risk of QT prolongation and ventricular arrhythmias.
49
Antmuscuranics
Doses
Ipratropium: SAMA 3-4 times a day
Tioptropium: LAMA ONCE daily
Aclidinium: LAMA TWICE daily (Genuair Eklira green to red button when dose is inhaled)
50
How many mls should dioralyte be dissolved in?
200 ml
51
In hypertension if patient is at risk of HF, oedema or intolerance what should be offered?
Thiazide like diuretics
52
Inhalers with dose counter
Ellipta
Genuair eklira
Nexthaler
Respimat
53
In piles what’s the difference between blood mixed in stools and bright blood on the stools?
Blood in stools can be a sign of a gastric ulcer or gastric carcinoma and requires referring whereas bright blood on the stool indicates fresh blood that is due to rectal bleeding which is a normal symptom of haemorrhoids
54
How long should a thermometer be placed under tongue?
3-4 minutes
55
What is microcytic anaemia?
Characterised by low MCV. Iron deficiency is most common cause. Associated with thalassaemia
56
Which is a referral point in otitis externa?
Conductive hearing loss or symptoms present for 4 or more days?
4 or more days. (Refer if more than 2 days)
57
Which one is not an excipient used in vaccine?
```
Formic avid
Gelatin
Penicillins
Polymyxin
Thiomersal
```
Formic acid
58
Research for evidence based clinical decisions?
Meta-analysis
59
Viral infections can cause neutropenia
.
60
Ispuagula husk and opioids?
Risk of faecal impaction. With isphagula husk you need to drink lots of water. Opioids have anticholinergic effects. Best laxative for opioid induced constipation is an osmotic such as lactulose.
61
Waste should not be stored for longer than how many months?
3
And no more than 5 cubic meters of hazardous waste can be stored at any one time
62
Re-audit performance is not part of one typical audit cycle
.
63
Which of the following is there a legalisation that prohibits you from administering the medicine without instructions from practitioner?
```
Soluble insulin
Diazepam rectal solution
Salbutamol inhaler
Adrenaline
Midazolam buccal solution
```
Soluble insulin
64
True or false EHC can be used more than once per cycle
Not recommended but can do
65
Which one will require everyone in household to be receive treatment?
Head lice
Scabies
Threadworm
Scabies and threadworm
66
What must be reviewed and recorded before commencing olanzapine?
Fasting blood glucose
67
Which test do you need before starting treatment with sodium valproate and/or simvastatin?
Serum ALT
68
Which anti cancer drug?
Patient has to undergo echodrography assessment before starting, side effects include diarrhoea, dehydration, can colour urine red. High cumulative doses are associated with cardiomyopathy and therefore dose is capped at 450 mg/m2
Doxorubicin
69
Which anti cancer drug is used for pulmonary fibrosis. Nasal lung crepitations or suspicious chest C-ray changes are indications to stop therapy.
Bleomycin
Also does not cause myelosupression
70
1. Cosmofer
2. Hydroxocobalamin (vitamin b12)
3. Filgrastim
4. Sodium bicarbonate
5. Calcium
6. Pabrinex (thiamine vitamin b1)
7. Sevelamer
8. Menadiol sodium phosphate
9. Cinacalet
1. Iron deficiency anaemia
2. Pernicious Anaemia
3. Neutropenia
4. Uraemic Acidosis
5. Hyperkalaemia
6. Wernicke's encephalopathy
7. High phosphate levels
8. Vitamin k deficiency
9. Hyperparathyrodism
71
Is keeping a running balance a legal requirement in the CD register?
No, good practice
72
Which antiepileptic can be given once daily due long half life?
Phenobarbital
73
Treatment with this medicine is associated with impulse control disorders, including pathological gambling, binge eating and hypersexuality
Dopamine agonists (Pramipexol, Ropinirole, Rotigotine, apomorphine)
74
Which class of anti-parkinsonian has been associated with fibrotic reactions and are therefore rarely used?
Ergot derived dopamine agonists (bromocriptine, carbegoline and pergolide)
75
Carbamazepine + TCAs
1. Carbamazepine will decrease TCAs
| 2. TCAs will antagonise anticonvulsant effect as they lower seziure threshold.
76
Which antidiabetic should be avoided in elderly due to risk of hypoglycaemia and in parkinson's patients due to confusion?
Sulphonylureas (especially long acting)
77
Which drug is indicated in the treatment of tremors in Parkinson’s disease which are not controlled by antiparkinsonian agents?
Trihexyphenidyl
78
Other than the obvious, what can happen in phenytoin toxicity?
Vitamin D metabolism abnormalities can occur
79
How often should penciclovir 1% be applied?
8 times a day
80
erythromycin + antacids
reduced absorption
81
1. NSAIDs with highest and lowest risk of thrombotic events?
2. NSAIDs with highest, lowest and intermediate risk of GI events?
3. NSAID with serious skin reactions?
1. Highest: diclofenac then ibuprofen. Lowest: Naproxen
2. Highest: Ketoprofen, ketorolac. Intermediate: Indometacin, diclofenac, naproxen. Lowest: Ibuprofen
3. Piroxicam
82
Hyponatraemia was reported with which TWO sulfonylureas?
Glimepiride
| Glipizide
83
True or False: Is allopurinol involved with a high risk of stevens-johnson syndrom?
True. Symptoms include: swollen face, ulcers inside cheek, itchy rash, dysphagia, blurry vision.
84
True of False: is Hydroxycarbamide cytotoxic?
True
85
Do enema preparations avoid first pass metabolism?
Yes. Access via haemorrhoidal vein
86
SSRI – sedative effect with alcohol but not a black dot interaction
SSRI – Black dot with naproxen as increased risk of bleeding
Omeprazole and clarithromycin increase each others’ plasma concentration but not a black dot interaction
Increased risk of bleeding when NSAID given with corticosteroid but not a black dot interaction
NSAIDs cautioned in patients with asthma who have reacted to NSAIDs in the past
.
87
Which antidiabetic needs to be stopped prior to using iodine-containing contrast media due to risk of renal failure
Metformin
88
Erik is taking digoxin. Dose of 125mcg daily is for atrial fibrillation or heart failure. Citalopram can cause QT-interval prolongation – answer is not B
SSRIs should be cautioned with other drugs that increase the risk of bleeding. Erik is taking aspirin. Answer is not A, E or H and B again
Amitriptyline is a tricyclic antidepressant and can cause drowsiness – Erik is a driver so would not be suitable. Answer is not D
Monoamine-oxidase inhibitors are cautioned in cardiovascular disease so answer is not F or G
Mirtazapine most appropriate
89
MOA of laxatives
Senna is a natural medicine derived from sennosides which act as a stimulant – stimulating contractions of the gut (gut peristalsis)
Docusate stimulates the gut and softens the stool
Lactulose draws fluid from the blood and the fluid it is drunk with
Arachis oil softens impacted stools
Glycerol causes peristalsis by irritating the area
Bulk forming laxatives cause stimulation by increasing faecal mass
90
What risk is zafarilukast associated with?
Liver toxicity
91
Nabilone
used for nausea and vomiting caused by chemotherapy; it is a cannabinoid
92
True or false: can co-beneldopa colour the urine and other body fluids?
Yes. Red
93
Stoma care: Iron supplements may cause loose stools and sore skin at the stoma site. Via what route should iron supplements be given if necessary?
Parenteral. Modified release should be avoided.
94
What is gray syndrome? symptoms? What's it caused by?
occurs due to excessive doses in neonates with immature hepatic metabolism. Symptoms include abdominal distension, cyanosis, circulatory collapse.
Cholramphenicol
95
Toxic epidermal necrolysis
potentially life-threatening dermatologic disorder characterised by widespread erythema, necrosis, and bullous detachment of the epidermis and mucous membranes, resulting in exfoliation and possible sepsis and/or death. Rare side effect of terbinafine
96
True or false: Suspected shingles is an emergency referral
True
97
Which organisms are most likely cause of an acute exacerbation of COPD? Treatment?
Moraxella catarrhalis, haemophilus influenza and strep pneum.
Treat with tetracyclines or amoxicillin or macrolides. (broad spectrum)
98
True or false: beta blockers are contraindicated in sever peripheral vasuclar disease
True. If already on it, reduce dose gradually until stopped.
99
Which is toxoid vaccine: diphtheria, hep B, Hib, HPV?
Diphtheria
100
In african descent patients or over 55 with hypertension and diabetes, do you start antihypertensive treatment as normal?
No, if diabetic add ramipril at step 1. So CCB + ACEi. aka start at step 2.
101
Avoid foods high in fibre in stoma care
E.g broccoli, grains etc
102
If a drug is licenced for use in animal does it have to say under cascade on prescription?
No
103
Quinolones + corticosteroids
Increase risk of tendon damage
104
If a patient had a course of antibotic recently and did not work. Should they change the AB or increase dose/duration?
Change antibiotic as there might risk of resistance.
105
Bath additives should not be applied directly to dry skin
Poses an ignition risk becuase of becuase of liquid paraffin and white soft paraffin.
106
Why is methotrexate contraindicated in sever infections such as pneumonia, sepsis etc?
Immunosupressant
107
In DKA what should happen to basal insulin?
Continue on same dose along side fluids and soluble insulin
108
Diuretics and NSAIDs can precipitate lithium toxicity. Which is more severe?
NSAIDs
109
Warfarin vs miconazole
Miconazole increases effect of warfarin. Potentially serious
110
```
Which is associated with highest risk of fatality in overdose?
Amitriptyline
lofepramine
mirtazapine
paroxetine
trazodone
```
Amitriptyline
Trazodone is related but has less effects. Lofepramine is least associated in comparison to others
111
Pioglitazone is contraindicated in
HF or past medical history of HF
112
NICE guidance following an MI states to use a high propensity statin (such as atorvastatin) initially with a view to switching over to a more cost-effective alternative such as simvastatin after a set period of time.
.
113
What measure is used for monitoring compliance in smoking cessation?
Carbon monoxide
114
A fair and just error reporting, analysis, and feedback system is an appropriate overarching safeguard to protect patient safety in relation to a medication error.
.
115
Nitrates need to be taken so as to leave an 8-hour nitrate free period to avoid tolerance. This is possible if the dose is taken regularly at 6 hourly intervals.
.
116
```
Which of the following drugs would NOT present a clinically significant interation with grapefruit juice?
Amiodarone
Codeine
Colchicine
Fexofenadine
Pravastatin
```
Pravatsatin. Only statin to avoid with grapefriuit juice is simvastatin.
117
A low neutrophil count requires withholding of methotrexate
.
118
Sildenafil is SLS for erectile dysfunction secondary to diabetes
.
119
Isotretinoin should be used for acne when
other topical antibiotics have failed
120
MHRA warning with metoclopramide
Risk of neurological (especially young women0 max use 5 days
121
Otomize ear spray
1 spray tds
122
Flixonase nasules
6 drops in each nostril daily
123
penicillin vs cephalosporin for UTI in pregnancy
Both safe but cephalosporins are more effective
