Part _ Data interpretation

Question 1

can carbamazepine lower sodium

Answer 1

yes

Question 2

slow AF on digoxin what should you do

Answer 2

stop digoxin

Question 3

in asthma exacerbation do you withhold the salbutamol inhaler

Answer 3

yes as you will be starting a salbutamol nebuliser

Question 4

pt with fast AF both BB and diltiazem CI what can you give

Answer 4

digoxin

Question 5

if ALT rises in statin use what do yo do

Answer 5

if less than 3 times limit do not exlcde
if over discountinue

Question 6

if taking levy for hypo and sx not improved after 3 months of tx what should you do if sx still present

Answer 6

slowly titrate dose

Question 7

major bleed on warfarin what do you do

Answer 7

dried prothobmin complex 50 units/kg IV or FFP

Question 8

when should you withold amiodarone

Answer 8

in thyrtoxicosis

Question 9

when do you stop a statin if ck is raised

Answer 9

only if 5 times the limit of ck

if sx resolve and ck level sreturn to nromal - restart statin at lower dose

Question 10

in addition to aspirin and gtn spray what else should be added fro person with unstabel angina

Answer 10

statin 80mg
diltizaem - as was asthmatic in stem - if not bb

Question 11

in hf what drugs imrpove long term prognosis

Answer 11

ACEi and BB

2nd line therapy inclued sglt-2 and spironolcatone

Question 12

how can you reduce the risk of contrast-induced nephropathy

Answer 12

adeuatw hydration pre and post scan

the evidence base currently supports the use of intravenous 0.9% sodium chloride at a rate of 1 mL/kg/hour for 12 hours pre- and post- procedure. There is also evidence to support the use of isotonic sodium bicarbonate
N-acetylcysteine has been given in the past but recent evidence suggests it is not effective*

Question 13

A 60-year-old man who has type 1 diabetes mellitus complains of reduced hypoglycaemic awareness. what drugs can cause this and why

Answer 13

Atenolol is a beta-blocker, which can mask the symptoms of hypoglycaemia, such as tachycardia and tremors, by blocking the effects of adrenaline. This can lead to reduced hypoglycaemic awareness in patients with diabetes mellitus. Additionally, beta-blockers may impair glucose metabolism and delay recovery from hypoglycaemia.

Question 14

Liver disease can impair the synthesis of vitamin K and hence increase a patients prothrombin time and INR. The other factors induce the P450 enzyme system and will therefore decrease a patients INR.

Answer 14

true

Question 15

for COPD PT what should the target O2 sats be

Answer 15

Management of COPD patients
prior to availability of blood gases, use a 28% Venturi mask at 4 l/min and aim for an oxygen saturation of 88-92% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis

Question 16

steriods commonly cause which one of these 3
insomnia
hyperkalamia
hypotension

Answer 16

isnomina

also cause hypok and hypertension

Question 17

he BNF suggests gradual withdrawal of systemic corticosteroids if patients have:

Answer 17

received more than 40mg prednisolone daily for more than one week
received more than 3 weeks treatment
recently received repeated courses

Question 18

Hba1c 48 as a percentage

Answer 18

6.5%

Question 19

does metronidazole affect warfarin

Answer 19

yes inhbits enxyme so INR increases

Question 20

can sulphonlyureas cause SIADH

Answer 20

yes this causing low sodium

Question 21

common meds that cause SIADH

Answer 21

sulphyureas
SSRI
TCA
carbmazepine
vincritsine
cyclophosphamide

Question 22

General factors that may potentiate warfarin

Answer 22

liver disease
P450 enzyme inhibitors (see below)
cranberry juice
drugs which displace warfarin from plasma albumin, e.g. NSAIDs
inhibit platelet function: NSAIDs

Question 23

A 30-year-old woman with type 1 diabetes mellitus is reviewed in clinic. She is currently using a ‘basal-bolus’ insulin regime consisting of three injections of a rapid-acting insulin analogue accompanied by intermediate-acting insulin once a day.

Select the two most appropriate investigations to assess how well controlled her diabetes is.

Answer 23

HbA1c and review hme blood gluocse readigns

Question 24

should you give IV glucose in stroke pt

Answer 24

no as risk of cerebral oedema

Question 25

The most recent TFTs show a suppressed TSH indicating over replacement. Even though she is asymptomatic the dose should be decreased to reduce risk of what

Answer 25

decreased to reduce the risk of osteoporosis and atrial fibrillation. The BNF recommends adjusting the dose by 25mcg in this age group.

Question 26

side effects of levy

Answer 26

hyperthyroidism: due to over treatment
reduced bone mineral density
worsening of angina
atrial fibrillation

Question 27

two interactions of levothyroxine

Answer 27

iron, calcium carbonate
absorption of levothyroxine reduced, give at least 4 hours apart

Question 28

intial starting dose of levo in elederyl or isc HD

Answer 28

The BNF recommends that for patients with cardiac disease, severe hypothyroidism or patients over 50 years the initial starting dose should be 25mcg od with dose slowly titrated.

Other patients should be started on a dose of 50-100mcg od

Question 28

if change to thyroxine dose when sohodl it be mesured again

Answer 28

8-12 weeks

Question 29

women with established hypothyrodisim should have dose of levo increased by how much

Answer 29

women with established hypothyroidism who become pregnant should have their dose increased by at least 25-50 micrograms levothyroxine due to the increased demands of pregnancy.

Question 30

‘My shoulder and leg muscles feel weak’ - with what drug

Answer 30

Proximal myopathy is common with longer term steroid use. Some of the other side-effects may of course be secondary to either the methotrexate or ongoing rheumatoid disease.

Question 31

maintainance values

Answer 31

25-30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride and
approximately 50-100 g/day of glucose to limit starvation ketosis

So, for a 80kg patient, for a 24 hour period, this would translate to:
2 litres of water
80mmol potassium

Question 32

two improtant things to tell pt about aledronate

Answer 32

stop tx and seek medicla advice if heartburn or pain on swallowing

regular dental checkups

Question 33

carbimazole sore throat what to test

Answer 33

FBC
TFT
Thyroid function tests should also be performed to see whether the patient is still thyrotoxic and to ensure they have not become hypothyroid.