passmed randoms

Question 1

signs that you will see in serotonin syndrome

Answer 1

lower limb hyperreflexia, ankle clonus, increased tone and a fine tremor in the upper limbs

Question 2

digoxin and sidenafil have vision changes due to the drug side effects what are they

Answer 2

Visual changes secondary to drugs
blue vision: Viagra (‘the blue pill’)
yellow-green vision: digoxin

Question 3

sidenafil moa

Answer 3

Phosphodiesterase type V (PDE5) inhibitors

short-acting - usually taken 1 hour before sexual activity

Question 4

contraindications to taking sidenafil

Answer 4

patients taking nitrates and related drugs such as nicorandil
hypotension
recent stroke or myocardial infarction (NICE recommend waiting 6 months)

Question 5

indications for liver transplant in paracetamol overdose

Answer 5

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

Question 6

pulmonary oedema and metabolic acidosis in aspriin overdose require what tx not - IV bicarb in this situation

Answer 6

haemolysis

Question 7

flecanide what class of drug

Answer 7

sodium channel blocker (specifically the Nav1.5 sodium channels).

Question 8

contraindications to flecanide

Answer 8

post myocardial infarction
structural heart disease: e.g. heart failure
sinus node dysfunction; second-degree or greater AV block
atrial flutter

Question 9

inhibtors of p450

Answer 9

antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin

Question 10

inducers of p450

Answer 10

antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)

Question 11

features of ecstasy

Answer 11

neurological: agitation, anxiety, confusion, ataxia
cardiovascular: tachycardia, hypertension
hyponatraemia
this may result from either syndrome of inappropriate ADH secretion or excessive water consumption whilst taking MDMA
hyperthermia
rhabdomyolysis

Question 12

what is nicorandil

Answer 12

anti-anginal drug which has dual properties of a nitrate and a potassium channel agonist. Since nitrate use is an absolute contraindication for prescribing sildenafil, nicorandil is the correct answer here.

Question 13

smokers carboxyhaemaglobin levels

Answer 13

Smokers may normally have carboxyhaemoglobin levels of up to 10%

Question 14

what is HIT - heparn induced thrombocytopenia

Answer 14

The correct answer is HIT is a prothrombotic condition. Heparin-induced thrombocytopenia (HIT) is an immune-mediated complication of heparin therapy. It leads to the formation of antibodies against complexes of platelet factor 4 and heparin, which can activate platelets and cause thrombosis, hence it is a prothrombotic condition.

Question 15

A 61-year-old man, who takes warfarin, comes to the GP for a blood test to measure his international normalised ratio (INR). He has a past medical history of atrial fibrillation and epilepsy. His target INR range is between 2 and 3. However, the blood test reveals an INR of 4. On questioning, he informs you that he was recently started on a new medication.

Which of these medications is most likely responsible for the change in INR?

Answer 15

Sodium valproate is an enzyme INhibitor so can INcrease warfarin levels if used concurrently

Question 16

Since cardiac bypass circuits are thrombogenic large doses of intravenous heparin are administered. This is reversed with

Answer 16

protamine sulphate. FFP may be effective but would carry a significant risk of fluid overload.

Question 17

triptans moa

Answer 17

serotonin agonsits

Question 18

drugs mechansim for BPH

Answer 18

alpha antagonist

Question 19

What drug will you administer to reduce the risk of isoniazid induced peripheral neuropathy?

Answer 19

Pridoxine (vitamin B6) should be co-administered with isoniazid to prevent peripheral neuropathy

Question 20

You are considering a diagnosis of Crohn’s disease in a 14-year-old boy who presents with gastrointestinal symptoms. Which one of the following is the most common symptom of Crohn’s disease in children?

Answer 20

abdo pain

Question 21

Organophosphate poisoning is characterised by the acronym ‘DUMBBELLS’ which stands for

Answer 21

Defecation, Urination, Miosis, Bronchorrhea, Bradycardia, Emesis, Lacrimation, Lethargy and Salivation

Question 22

mechanism is not delineated but it is thought to inhibit central cholinergic receptors, and thus balance cholinergic and dopaminergic activity in the basal ganglia - oculgyric crisis - what are some of the features and how is it treated

Answer 22

agitated and restless
sustained upward deviation of the eyes

Question 23

back pain - spinal mets treat with what

Answer 23

bisphosponares and radiotherapy

Question 24

most effevtive pain relief in children

Answer 24

paracetamol

Question 25

inducers do what to ciclosporin

Answer 25

decrease ciclosporin levels and lead to transplant rejection

Question 26

Anaphylactoid reactions to IV N-Acetylcysteine are generally treated

Answer 26

stopping the infusion, then restarting at a slower rate

Question 27

moa aspirin

Answer 27

Inhibits the production of thromboxane A2

Question 28

Patients with MI secondary to cocaine use should be given IV

Answer 28

benzodiazepines as part of acute (ACS) treatment

Question 29

Amiodarone may cause precipitation of what drug

Answer 29

digoxin - as inhibtor of p450

Question 30

Azathioprine is a prodrug, meaning it is metabolised to its active form, 6-mercaptopurine, which causes immunosuppression (preventing kidney rejection in this patient). The active 6-mercaptopurine is subsequently metabolised by xanthine oxidase to inactive this uric acid which is excreted. As allopurinol inhibits xanthine oxidase, the combination of the two drugs can lead to excessive myelosuppression and therefore increase the risk of

Answer 30

neutropenic sepsis

Question 31

low mg cause drug common

Answer 31

ppi

Question 32

aboid what abx in renal failure or disease

Answer 32

tetracycline, nitrofurantoin