Past paper qs

Question 1

Normal HB levels

Answer 1

For men, 13.5 to 17.5 grams per deciliter.

For women, 12.0 to 15.5

Question 2

Normal MCV

Answer 2

80-100

Question 3

Stage 1 hypertension is
Stage 2
Stage 3

Answer 3

1. > 140/90
2. 160/100
3. 180/110

Question 4

Target BP for > 80 years old

<80 years old

Answer 4

150/90

140/90

Question 5

Target BP if pregnant (uncomplicated)

Target BP if preg with target organ damange secondary to hypertension

Answer 5

150/100

140/90

Question 6

Step 1 Drug treatment for hypertention
Step 2
Step 3

Answer 6

1 < 55 = ACE
> 55 / black = CCB
2 ACE + CCB
3 + thiazide like diuretic

Question 7

Normal TSH levels
T4
T3

Answer 7

TSH 0.4 to 4 (mIU/L).
T4 9.0-25.0 pmol/L
T3 3.5 - 7.8 pmol/L

Question 8

Albumin - normal level

Answer 8

35-55

Question 9

Surgical contamination levels

Answer 9

CLEAN - in which no inflammation is encountered and the respiratory, alimentary
or genitourinary tracts are not entered. There is no break in aseptic operating theatre
technique. (e.g. ENT)

CLEAN CONTAM - in which the respiratory, alimentary or genitourinary tracts are entered but
without significant spillage.

CONTAMINATED - Operations where acute inflammation (without pus) is encountered, or where there
is visible contamination of the wound. Examples include gross spillage from a hollow
viscus during the operation or compound/open injuries operated on within four hours.

DIRTY - Operations in the presence of pus, where there is a previously p

Question 10

ASA levels and what do they show?

Answer 10

ASA - > 2 is increased risk of wound infection

1 A normal healthy patient
2 A patient with a mild systemic disease
3 A patient with a severe systemic disease that limits activity, but is not incapacitating
4 A patient with an incapacitating systemic disease that is a constant threat to life
5 A moribund patient not expected to survive 24 hours with or without operation

Question 11

normal aptt

Answer 11

30-40 seconds

Question 12

what is the effect of addisons on Na levels

Answer 12

Low

Question 13

What is the effect of SIADH on Na

Answer 13

Low

Question 14

Effect of lithium on electrolytes

Answer 14

all increase

Question 15

Effect of digoxin on electrolytes

Answer 15

increase k and reduce mg

Question 16

Effect of NSAIDs on electrolytes

Answer 16

increase k and reduce na

modulation of Renin angiotensin system

Question 17

overactive parathyroid has what effect on calcium

Answer 17

increase

parathryoid hormone stimulates release of Ca stores from the bines

Question 18

Risk of clozapine

Answer 18

Agranularcytosis (low neutrophils)

Question 19

What drug has yellow vision as a side effect?

Answer 19

Dig

Question 20

What electrolyte inbalences predispose to dig toxicity

Answer 20

Low K or Mg

Question 21

What is EDTA

Answer 21

measurement or renal funciton with radioactive traker

Question 22

NICE renal function calssificaions

Answer 22

1 >90
2 60 - 89
3A 45 -59
3B 30-44
4 15-29
5 < 15

Question 23

If converting between opiates we should reduce by …… to account for differences if metabolism

Answer 23

30%

Question 24

How to interpret Volume of distribution

Answer 24

If LESS than 0.65L/kg the drug stays in the blood -> dose on IBW (e.g. Amikacin)

If MORE thank 0.65 L/kg the drug goes into the fat -> dose on Actual Weight
- IT TAKES THESE DRUGS AGES TO GET TO STEADY STATE SO THEY NEED (long half life)

Question 25

Gamma GT indicates

Answer 25

most sensitive marker of hepatic disease | alcohol / drug damage

Question 26

Alk Phos idicates

Answer 26

Inflammation and cholestatsis

Question 27

Transaminiaes indicate | which is more liver specific

Answer 27

Dammage/death from inflammation | ALT more spec than AST

Question 28

Bilirubin indicates

Answer 28

Cholestasis and synth function

Question 29

Albumin and PT indicate what in liver impairment

Answer 29

Synthetic fuction - albumin long term (20 days) and PT short term (3 days)

Question 30

Causative organisms for LRTI

Answer 30

Streptococcus pneumoniae, Haemophilus influenzae ATYPICALS Mycoplasma pneumoniae Chlamydophila ( Chlamydia) pneumoniae Legionnaires disease ( Legionella pneumophila)

Question 31

What happens with atypical organisms on the gram stain

Answer 31

nothing - colourless | +VE purple, -ve pink

Question 32

How does aneamia of chronic disease differ from iron deficiency

Answer 32

Ferritin is low in iron deficiency - trying to mobilise iron stores Ferritin is high in chronic disease - trying to store iron Iron biding capacity is always the oposite

Question 33

Drugs that could cause a macrocytic anemia

Answer 33

Anything disrupting folate - phenytoin, methotrexate tc

Question 34

Two phases of metabolism

Answer 34

Phase 1 - Oxidation, reduction, hydrolysis - CYP450 - Allows entry into phase 2 or excretion Phase 2 - Conjugation

Question 35

Is phase I or II more likely to still work in liver failure

Answer 35

II e.g. pick lorazepam instead of chlordiazepoxide in decompensated liver failure - these enzymes are more deep in the liver and less likely to be damaged

Question 36

What results could suggest liver failure is decompensated?

Answer 36

High INR | Increased ammonia

Question 37

When do you counsider dose reduction in liver fail (5)

Answer 37

- narrow theraputic index - more phase 1 dependent - bili > 100 - INR > 1.3 - presence of encephalopathy or ascities

Question 38

What is the role of calcium in high k

Answer 38

Calcium (either gluconate or chloride): Reduces the risk of ventricular fibrillation caused by hyperkalemia. Where as calcium resonium is used to actually reduced k

Question 39

For asicitc drain how much fluid should be lost: per day - without odema - with odema

Answer 39

- without 0.5 | - with 1kg/day

Question 40

Insulin reduces or increases potassium

Answer 40

reduces

Question 41

target HbA1c

Answer 41

 48mmol/mol (6.5%) if diabetes is managed by lifestyle and diet OR lifestyle and diet combined with a single drug not associated with hypoglycaemia,  53mmol/mol (7.0%)

Question 42

Cut of eGFR for metformin

Answer 42

45

Question 43

Pioglitazone side effects

Answer 43

(heart failure, bladder cancer, bone fracture). Known risk factors for these conditions including increased age should be carefully evaluated before treatment. MHRA advise that prescribers should review treatment after 3 to 6 months and only continue if patient is deriving benefit.  Do NOT offer or continue pioglitazone if any of the following are present:  heart failure,  hepatic impairment,  diabetic ketoacidosis,  current, or history of, bladder cancer,  uninvestigated macroscopic haematuria.

Question 44

Types of ADR ABCDE

Answer 44

ADRs A – Augmented – dose dependent and predictable (e.g. hypo from insulin) B – Bizarre – rare (e.g. anaphylaxis from penicillin) C – Chronic/chemical – prolonged treatment (e.g. analgesic neuropathy, paracetamol hepatotoxicity) D – Delayed – after years of treatment (e.g. antipsychotics and tardive dyskineseas) E – End of treatment – (e.g. seizures after stopping phenytoin)

Question 45

3 types of incompatibility

Answer 45

physical -precipitation chemical - decomposition of the drug theraputic - antagonistic effectts

Question 46

Factors affecting if medicines are transferred into breastmilk (4)

Answer 46

Size of molecule High lipid solubility Low meternal plasma protein binding Weakly acidic (milk is pH 7.2, plasma is 7.4) Usually via passive diffusion across the membrane

Question 47

Problem excipients for children: Propylene glycol

Answer 47

cannot be metabolised - CNS depression

Question 48

Problem excipients for children: sorbitol

Answer 48

artificial sweetener - osmotic diarrhea and GI discomfort