Passmed year 5

Question 1

what is hypoactive delirium

what causes it

Answer 1

a subtype of delirium characterised by withdrawal and sleepiness

dehydration and organ failure

Question 2

what psych drugs asscoiated with increased VTE risk

Answer 2

antipyschotic such as clozapine and aripiprazole

Question 3

side effects of beta blockers (5)

Answer 3

bronchospasm
cold peripheries
fatigue dizzy and lightheaded
sleep disturbances, including nightmares
erectile dysfunction

Question 4

what type of memory loss do benzos cause

Answer 4

anterograde amnesia - future

Question 5

how does aripiprazole protect against gynaecomastia

Answer 5

reduces prolactin level
partial agonist D2 receptors

Question 6

main sx of discontinuation sydrome of SSRI

Answer 6

Gi problems

Question 7

How often do you monitor SSRI bloods in over and uner 25 yr old

Answer 7

1 week if under 25
2 weeks if over 25year old

Question 8

what psychotherapy is good for EUPD

Answer 8

dialectical behaviour therapy DBT

Question 9

What drugs can predispose to digoxin toxicity and hwo

Answer 9

indapamide - thiazide as cause low potassium - Low potassium levels increase the binding of digoxin to its receptor (the sodium-potassium ATPase), enhancing its effect and increasing the risk of toxicity

Question 10

A 72-year-old man has been recently diagnosed with active tuberculosis by respiratory specialists and has been commenced on the initial phase of antibiotic treatment. He has a background of chronic kidney disease stage 4 and atrial fibrillation for which he takes warfarin. An INR taken 3 days after commencing treatment comes back at 8.2.

What antibiotic is most likely to be responsible for this finding?

Answer 10

Isoniazid inhibits the cytochrome p450 system. This inhibition reduces the metabolism of warfarin causing a prolongation of its effects which subsequently increases the INR.

Question 11

carboxyhaemoglobin is it raised in smokers

Answer 11

Smokers may normally have carboxyhaemoglobin levels of up to 10%

Question 12

what does nuchal rigidity mean

Answer 12

Nuchal rigidity refers to neck stiffness caused by bacterial meningitis and other serious medical conditions.

Question 13

mechanism of aspirin

Answer 13

Inhibits the enzyme cyclooxygenase (COX), which blocks the production of thromboxane and prostaglandins that cause inflammation, swelling, pain, and fever.

Question 14

mechanism of clopidogrel

Answer 14

Inhibits the binding of adenosine diphosphate (ADP) to the platelet P2Y12 receptor, which blocks platelet activation and aggregation.

Question 15

what other drug is like warfarin affected by p450 system

Answer 15

ciclosporin

Question 16

how might an inducer affect ciclosporin levels

Answer 16

St John’s Wort is an inducer of the P450 system and can decrease ciclosporin levels, leading to transplant rejection

Question 17

common side effect of sidenafil

Answer 17

headaches

Question 18

what anticoag/antiplatelet can cause a promthrombotic state

Answer 18

LMWH - Heparin induced thrombocytopenia is a prothrombotic state

Question 19

why cant you use warfarin alone for prophylactic tx

Answer 19

Warfarin is prothrombotic in the first few days of treatment. Due to this, patients starting on warfarin should be covered with heparin until their international normalised ratio (INR) is within an acceptable range.

Question 20

under what eGFR can you use LMWH till - what can you use instead

Answer 20

A LMWH such as dalteparin may be used when eGFR <15ml/min but not at treatment dose. Instead, a reduced dose of LMWH or UFH should be used.

Question 21

pneumonic to remember organophosphate poisoning

Answer 21

DUMBELS’:
D: defaecation & diaphoresis.
U: urinary incontinence.
M: miosis (pupil constriction).
B: bradycardia
E: emesis.
L: lacrimation.
S: salivation.

Question 22

Isoniazid 2 se

Answer 22

hepatitis, agranulocytosis

Question 23

Pyrazinamide 4 se

Answer 23

hepatitis, arthralgia, myalgia, gout

Question 24

Clarithromycin

Answer 24

GI upset
Cholestatic jaundice - used for various mycoplasma infections e.g. mycoplasma pneumoniae

Question 25

Rifampicin se

Answer 25

hepatitis, orange bodily secretions

Question 26

how do you treat miroprolactinoma

Answer 26

dopamine agonist

Question 27

when do you measure heparin

Answer 27

No routine monitoring needed, but in special situations check anti-Factor Xa levels
35%

Question 28

side effect of mg salts oral

Answer 28

diarrhoea

Question 29

Digoxin toxicity is more likely to occur in the presence of hypokalaemia. why

Answer 29

This is because digoxin and potassium compete for binding sites on the Na+/K+ ATPase pump, which is inhibited by digoxin as part of its mechanism of action. When potassium levels are low, there is less competition for these binding sites, allowing more digoxin to bind and exert its effects, thus increasing the risk of toxicity.

Question 30

monitoring of unfractionated heparin is required hwo do you montiro this

Answer 30

Unlike low molecular weight heparins that do not require monitoring unfractionated heparin does require monitoring, this is done by measuring the APTT.

Question 31

4 side effects of heparin

Answer 31

bleeding
thrombocytopenia - see below
osteoporosis and an increased risk of fractures
hyperkalaemia - this is thought to be caused by inhibition of aldosterone secretion

Question 32

long term thiamine if

Answer 32

alcoholic

Question 33

platelets raised

Answer 33

in clumped states
such as infection ball in discitis so reducing platelets is a good sign