MRCP PCT Flashcards
1
Q
Role of protein C
A
inactivate factor 5a and 8a
2
Q
Meptazinol
A
mu opioid partial receptor agonist
low constipation rate
3
Q
Antiemetics that cause prolonged QT
A
metoclopramide
ondansetron
prochloperazine
4
Q
Zolendronic acid can be pain control for…
A
Bone pain with bone mets
5
Q
Fentanyl patch useful in…
A
stable morphine who cannot take due to side effect or poor renal fx
6
Q
Renal function for fentanyl patch
A
safe in eGFR <30
7
Q
Diazepam acts on…
A
GABA-A
8
Q
MND patients with respiratory distress at end of life…
A
NIV improves comfort
9
Q
Glycopyrronium side effect
A
dry mouth
10
Q
Cytotoxic agent that causes cardiomyopathy…
A
doxirubicin
herceptin
11
Q
Anaplastic thyroid cancer (poor prognosis) spread to…
A
LUNGS mostly
12
Q
Liver capsule pain can be managed by…
A
Dexamethasone
13
Q
Gabapentin bings to…
A
alpha 2 delta of VGCaChannel
14
Q
`
serotonin syndrome vs neuroleptic malignant syndrome
A
hyperreflexia vs hyporeflexia
15
Q
Side effect on ondasetron
A
constipation
16
Q
Antiemetics contraindicated in PD
A
haloperidol
metoclopramide
17
Q
Steroid side effect
A
psychosis
18
Q
Side effect of amitriptylline
A
anti-cholinergic effects
19
Q
Laxative for opiate induced constipation
A
First: Stimulant laxative (Senna)
Second: Osmotic (macrogol/lactulose)
Third: docusate if colic
20
Q
Hyoscine (buscopan) side effect
A
dry mouth
anticholinergic
21
Q
Breakthrough pain with synringe driver
A
subcut morphine
22
Q
DNAR
A
medical decision
23
Q
side effect of fentanyl…
A
generalised itching and sweating and rash
24
Q
Option for local pain management in pancreatic cancer when PCM, ibu, MST does not work
A
coeliac plexus block
25
WHO pain ladder
Para --> ibu --> weak opioid (codeine/dihydrocodeine/tramadol) --> morphine
26
CKD patient pain relief
oxycodone not morphine
27
28
Drug that increases life expectancy in MND
Riluzole
29
240mg codeine to morphine
20mg morphine
30
Antiemetic receptors
Ondansetron= 5HT
Domperidone=dopamine antagonist
Metoclopramide=dopamine antagonist
Aprepitant = nk-1 receptor (chemo related N+V)
31
Morphine conversion
Oral morphine /2 : sc morphine , oral/sc oxycodone
Oral morphine /3 : sc diamorphine
Morphine 12 mg : buprenorphine 5microgram
Morphine 30mg : 12 fentanyl
Breakthrough ⅙ to 1/10th of regular morphine .
codeine/tramadol to oral morphine = divide by 10
32
Marie curie nurses
help those who wish to die at home
33
Prognosis discussion
if patient does not want to know do not inform
34
Treatment for Colicky pain
hyoscine
35
oral morphine --> subcut morphine
divide oral morphine by 2
(takes into account surpassing first pass metabolism)
36
Fluids in EOL
may cause fluid overload
does not affect rate / timing of death
37
Severe hyponatraemia <125
SEIZURES
38
Bleomycin toxicity
pneumonitis
| non productive cough, SOBOE, bibasal creps
39
40
Adrenal metastasis
hypoadrenalism
abdo pain, vomit, weakness
low BP
low Na
high K
41
Side effect of amiodarone
hepatotoxicity
pulmonary fibrosis
thyroid issues
prolonged QT
pancreatitis
CORNEAL DEPOSIT
42
Cisplatin side effects
ototoxic
hypocal
hypomag
hypokal
nephrotoxic
43
FEV1 contraindicated for pneumonectomy
FEV1<2 in pneumonectomy
FEV1<1.5 for lobectomy
44
lorazepam low dose
useful in SOB
45
CPR with PE
continue CPR for 60-90 min post fibrinolysis (unless ROSC) to allow PE to dissolve
46
47
trastuzumab....
can cause dilated cardiomyopathy
hence HF
48
49
Antiemetic for hypercalcaemia
Haloperidol (D2 antagonist)
Second line: metoclopramide (acute dystonia side effect)
50
Chemo antiemetics
cyclizine
ondansetron
51
Diazepam
muscle spasm
52
Acinic keratosis management (atypical keratinocyte)
topical 5-FU
53
LBD
triad:
fluctuating confusion
persistent visual hallucination
spontaneous parkinsonism
note: extreme reaction to neuroleptics
54
What is nitrate tolerance
increases reactive oxygen spp from vascular oxidative stress--~> inhibiting activation of nitrate
54
Myeloproliferative diseases
- too many cells from bone marrow
Polycythaemia vera
CML
Myelofibrosis
Essential thrombocytosis
55
Lymphoproliferative disease
CLL
Follicular lymphoma
DLBCL
56
Myelodysplastic syndrome
- abnormal dysfunction cells from marrow - low counts
ring sideroblast
HIGH BLAST CELLS
57
Restless leg syndrome
discomfort in legs and urge to move
better with movement
crawling feeling
iron deficiency associated
58
P450 inducer - decreases INR
rifampicin
phenytoin
carbamazepine
st johns wort
59
P450 inhibitor - increases INR
erythromycin
metronidazole
ciprofloxacin
allopurinol
60
Legionella transmission via..
warm water source via aerosol
61
Management of LBD
rivastigmine (cholinesterase inhibitor)
62
Thiazide diuretic...
hypercalcaemia
worsening glucose tolerance
low potassium/sodium/magnesium
hypochloraemic alkalosis
63
squamous cell carcinoma of skin
ulcerated nodular lesion
surrounding parathesia and hyperkeratosis
Mx: surgical excision (risk of LN mets)
64
Reverse splitting of S2
AS
HOCM
LBBB
65
Giant v wave
tricuspid regurg
66
variable S1
CHB
67
Heparin induced thrombocytopenia
risk of venous thrombotic event
68
SIADH
urine sodium >40
urine osmolality HIGH
69
MI
LAD - anterior
LCx - lateral
RCA - inferior
70
Listeria meningitis
Low glucose
high protein
lymphocytic
71
TB management
RIPE for 4 months
RI to continue for 2 further
72
TB management in deranged LFT (liver friendly regimen)
streptomycin/moxifloxcin
73
What is creatitine
cation
drugs can interfere with creatinine secretion--> lead to self limiting and reversible rise in creatinine without changing eGFR
e.g trimethoprime and cimetidine
74
Normal pressure hydrocephalus
trial of CSF removal
75
Gait in parkinsons
NARROW short shuffling gate
76
Donepazil in alzheimers
acetylcholinesterase inhibitor
77
Rasagiline in parkinsons
MAO B inhibitor
78
Medication increasing risk of GOUT
diuretics
79
Mechanism of digoxin
inhibit sodium potassium ATPase in sarcomere
80
Why is there delay in digoxin action (few days)
digoxin binds to proteins and widely distribute in body tissues
81
Management for CLL
First: FCR combination therapy
- fludaraine,
- cyclophosphamide,
- rituximab
Second: Alemtuzumab (CD52)
82
Osteomalacia
low vit D --> low calcium --> PTH increase (secondary) --> trashing phosphate
83
High ALP in osteomalacia
due to increased osteoblasts
84
Delirium vs dementia
fluctuating impaired consciousness => acute delirium
85
age >65 vaccine
yearly influenzae
one off pneumococcal
86
Surgical management of aortic stenosis...
based on clinical sx - syncope chest pain worsening LVF
87
Potassium sparing diuretics
amiloride
spironolactone
88
homonymous hemianopia
contralateral occipital lesion (posterior cerebral artery)
note: macular sparing as macular collaterals from MCA
89
Empirical abx for meningitis in >65/immunocompromised
meningococcal and pneumococcal and listeria
cef, amox, aciclovir
90
causes of RBB
ASD
PE
HTN
91
causes of LBB
CAD
AS
HOCM
MI
92
Huntington disease
caudate nucleus
chorea
CC
93
Hippocampus
memory
temporal lobe epilepsy
schizophrenia
94
Thalamus
sleep regulation
eye saccade movement
95
Cirpofloxacin side effect
Tendo rupture
96
Stroke management
rule out haemorrhage with CT
past 4.5hr -> aspirin 300
switch to clopi 75 after 2 weeks
within 4.5hr -> alteplase
97
Common cause of TIA
carotid artery steonsis
98
Lacunar infarct
persistent focal deficits
no changes in initial imaging
99
commonest cause of AS
young- bicuspid
old- calcification
100
Amiodarone action
K channel antagonist
--> delay depol
--> increase refractory period
101
NaBKCa
Na - lidocaine, flecainide
B- bisoprolol
K- amiodarone, sotalol
Ca - verapamil, diltiazem
102
Halflife of amiodarine
long (up to 1 month)
therefore needs loading dose
103
Digoxin toxicity
vomiting
confusion
yellow visual field
104
Management of MSRA s.aureus
asymptomatic- topical decolonisation (risk of spread to others)
invasive -> IV vanc
105
Management of hallucination and agitation in parkinson
low dose atypical antipsychotic
- quetiapine
avoid typical antipssychotics (has anti-dopamine effect)
106
Entacapone (to prevent OFF)
COMT inhibitor
- prevent breakdown of levodopa in brain
107
Alzheimers management
Mild to moderate
- acetylcholinesterase inhibitor
donepezil
rivastigmine
galantamine
Severe (MMSE <10 and ADL)
- memantine
108
Irradiated RBC for...
on chemo (purine analogue)
--> reduced T cell
--> risk of transfusion associated GVHD
109
Weber syndrome
third nerve palsy
contralateral hemiparesis
midbrain lesion
at base!
basillar
110
anterior communication cerebral artery stroke
optic chiasm
visual field defect
111
Vertebral artery dissection (stroke)
PICA--> lateral medullary syndrome
112
Why is NIV contraindicated in hypotension
reduced venous return and cardiac output
--> due to high lung pressures
113
carcinoid syndrome common sx
Diarrhoe
fascial flushing
114
What medication can you add in parkinsons to reduce dyskinesia
amantadine
NMDA receptor
115
Side effects of levodopa
dyskinesia
116
loperamide
Exclude infective gastroenteritis first
117
Parkinsons plus
PD- tremor, asymetric, late postural instability
LBD
PSP- early falls + postural instability, verical supranuclear gaze palsy, symmetrical axial and limb parkinsonism
MSA- postural hypotension
118
