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1
Q

What is the first line treatment for dyspepsia?

1) For immediate relief
2) For prophylaxis / long term prevention

A

1) Magnesium carbonate (antacid)

2) Omeprazole (PPI)

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2
Q

Give two causes of dyspepsia

A

Corticosteroids
NSAIDs
CCB
BBs

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3
Q

What is the first line treatment for croup?

A

Dexamethasone PO

Nebulised adrenaline if severe

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4
Q

What is the first line treatment for depression or generalised anxiety?

A

SSRI e.g. sertraline or citalopram

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5
Q

Give two common side effects of SSRIs

A

Anxiety
Dry mouth
Sexual dysfunction
GI (constipation / diarrhoea)

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6
Q

What is the treatment for Otitis Media?

A

Analgesia - Paracetamol or ibuprofen

Antibiotics - Amoxicillin 7d PO (Clarithromicin if allergic)

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7
Q

What is the treatment for overactive bladder?

A

Oxybutynin Hydrochloride

Be careful! Anticholinergics are contraindicated in patients with myaesthenia gravis.

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8
Q

What is the treatment for hypothyroidism?

A

Levothyroxine sodium

Take 30 mins before breakfast/caffeine/other meds
Monitor TSH every 2-3 months then annually once stable.

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9
Q

What is the treatment for hyperthyroidism?

A

Carbimazole

Be careful! Carbimazole can cause bone marrow suppression (neutropenia/agranulocytosis). Stop if any signs of neutropenia.

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10
Q

What is the first line treatment for acute asthma?

A

1) Salbutamol inhaled high dose
2) Salbutamol nebulised
3) Oral prednisolone (+ normal ICS)
4) Neb ipratropiumbromide
5) Magnesium sulphate IV
6) Aminophylline IV

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11
Q

What is the treatment for unstable angina?

A

[MONA]

Morphine
Oxygen
Nitrates - GTN
Antiplatelets - Aspirin + Clopidogrel

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12
Q

What is the treatment for chronic asthma?

A

SABA inhaled
ICS (if SABA needed >3x/wk)
If ICS not enough + LTRA e.g. montelukast
Or MART (ICS + LABA)

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13
Q

What is the treatment for COPD chronic and exacerbation?

A

Chronic:

1) SABA
2) LABA
3) ICS
4) If cannot inhale then Modified Release Theophylline
5) Azithromycin prophylaxis for infection

Exacerbations:

1) SABA nebulised
2) Oral prednisolone
3) Oxygen

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14
Q

What is the treatment for shingles?

A

Aciclovir PO 7d.

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15
Q

What is the treatment for anaphylaxis?

A

500 ug adrenaline (0.5ml) 1:1000
(repeat every 5 mins)

Chlorphenamine IV 10mg
Hydrocortisone IV 200mg

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16
Q

What is the treatment for osteoporosis?

A

Bisphosphonates e.g. alendronic acid

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17
Q

How do you take bisphosphonates?

A

Before breakfast
Tall drink of water
Sit upright for 30 mins after

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18
Q

What is the treatment for hypercholesterolaemia?

A

Statin e.g. Simvastatin

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19
Q

When should statins be taken?

A

Once nightly

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20
Q

What is a serious adverse effect of bisphosphonates?

A

Osteonecrosis of the jaw

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21
Q

What should patients be advised to report when taking statins?

A

Any unexplained muscle pain or weakness.

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22
Q

What food should patient’s on statins avoid?

A

Grapefruit juice

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23
Q

What is the treatmentfor bipolar disorder?

A

Lithium carbonate

Sodium valproate is an alternative if Lithium is contraindicated

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24
Q

How is lithium monitored?

A

Routine serum-lithium monitoring should be performed weekly after initiation and after each dose change until concentrations are stable, then every 3 months for the first year, and every 6 months thereafter. Samples taken 12 hours after the dose.

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25
Q

What is the first line treatment for migraine?

A

Ibuprofen/Aspirin/Sumatriptan [All are first lines]

NB: Seizure risk, risk of coronary artery disease, controlled hypertension and elderly are all contraindications for sumatriptans.

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26
Q

What drug is contraindicated in patients with migraine with aura and why?

A

COCP

Increases risk of stroke.

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27
Q

True or false, lithium dose depends on weight?

A

True. <50kg or >50kg

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28
Q

What is the first-line treatment for BPH?

A

Tamsulosin Hydrochloride

Micturition syncope and postural hypotension are contraindications.

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29
Q

What do you give for DVT/PE thromboprophylaxis in a surgical/hospital setting?

A

LMWH e.g. dalteparin

Then post discharge DOAC e.g. apixaban

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30
Q

When is unfractionated heparin preferred to LMWH?

A

Renal impairment

Mechanical heart valve

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31
Q

What do you give for DVT/PE thromboprophylaxis in a primary care setting?

A

Apixaban (DOAC) or LMWH

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32
Q

True or false, warfarin is safe in pregnancy?

A

False. Its teratogenic

LMWH is the choice in pregnancy.

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33
Q

How often should you monitor INR when on warfarin?

A

Daily early on then every 12 weeks once stable.

Patient is given a treatment booklet and alert card.

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34
Q

True or false, metformin is contraindicated in renal impairment?

A

True. If eGFR is less than 30. Risk of lactic acidosis.

Sulfonylurea is preferred.

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35
Q

True or false, metformin induces weight loss?

A

True.

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36
Q

What is the treatment for acute gout?

A

Ibuprofen or Colchicine

Remember to give a PPI with Ibuprofen!

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37
Q

What is the treatment for chronic gout?

A

Allopurinol

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38
Q

What is a very common side effect of allopurinol?

A

Rash

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39
Q

What is the treatment for erectile dysfunction?

A

Sildenafil (oral phosphodiesterase type 5 inhibitor)

Take 1 hour before. Onset may be delayed if taken with food.

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40
Q

What is the first line treatment for alcohol dependence?

A

Acamprosate Calcium
Naltrexone
Disulfiram

If suspected Wernicke’s then Thiamine!

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41
Q

What is the first line treatment for delirium tremens?

A

Oral lorazepam

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42
Q

What is the first line treatment for nausea?

A

Cyclizine or Ondansetron

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43
Q

What is the treatment for trigeminal neuralgia?

A

Carbamazepine

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44
Q

What advice would you give someone taking carbamazepine?

A

Seek immediate help if bleeding, bruising, mouth sores.

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45
Q

How do you monitor carbamazepine?

A

Plasma concentrations after 1-2 weeks

NB: Thai or Han chinese risk of HLA-B 1502 allele –> stevens johnson syndrome

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46
Q

True or false COCP is contraindicated in people who are over 35 and smoke?

A

True. >15 cigarettes/day.

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47
Q

What is the first line treatment for Crohn’s disease?

A

Methotrexate

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48
Q

How often is methotrexate taken?

A

Once weekly

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49
Q

True or false, methotrexate is contraindicated in active infection.

A

True.

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50
Q

What patient advice would you give to a patient starting on methotrexate?

A

Seek immediate help if you experience a sore throat or bruising.

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51
Q

What is the first line treatment for focal seizures?

A

Carbamazepine / Lamotrigine

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52
Q

What is the first line treatment for generalised seizures?

A

Sodium valproate / Lamotrigine

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53
Q

How long must you not drive for following a seizure?

A

1 year

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54
Q

True or false, it is acceptable to write Tazocin on a prescription?

A

False. Its a brand name.

Piperacillin with tazobactam is preferred.

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55
Q

What is the first line treatment for cluster headaches?

A

Sumatriptan SC injection

100% oxygen

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56
Q

Name 2 drugs to stop prior to surgery?

A

[I LACK OA]

Insulin 
Lithium 
Antiplatelets 
COCP/HRT 
K-sparing diuretics 
Oral hypoglycemics e.g. metformin
ACEi
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57
Q

What is the maximum dose of paracetamol per day?

A

4g / day

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58
Q

What is the WHO opiate ladder?

A

NSAID / Paracetamol
Weak Opiate: Codeine, Tramadol
Strong Opiate: Morphine, Oxycodone

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59
Q

True or false, Tazocin is safe for patients with penicillin allergies?

A

False

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60
Q

True or false, ACEi can cause hyperkalaemia?

A

True.

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61
Q

What is the treatment for H. pylori?

A

Triple therapy [PAM]

  • PPI
  • Amoxicillin
  • Metronidazole
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62
Q

What is the treatment for allergic rash (not anaphylaxis)?

A

Chlorphenamine (PO)

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63
Q

How often do you give adrenaline in anaphylaxis?

A

Every 3-5 minutes
IV 1mg

[Amiodarone also given IV 300mg if shockable]

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64
Q

What is the first line treatment for acne?

A

Benzoyl peroxide (Topical)

Topical Erythromycin/Clindamycin (2nd line)
Tetracycline PO (3rd line)
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65
Q

What is the treatment for alcohol withdrawal?

A

Chlordiazepoxide hydrochloride PO QDS

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66
Q

What is the first line treatment for constipation?

A

Lactulose 15ml BD PO (osmotic)

67
Q

What is a first line treatment for nausea?

A

Cyclizine or Ondansetron

68
Q

Name two drugs you should stop perioperatively

A 
Lithium 
Antiplatelets
COCP/HRT
K-sparing diuretics
Oral Hypoglycemics e.g. metformin 
ACEi
69
Q

Give two side effects of steroids.

A 
Stomach ulcers
Thin skin 
Oedema
Osteoporosis 
Infection 
Diabetes
Cushing's
70
Q

Give two contraindications for NSAIDs

A 
Renal failure
Heart failure
Asthma 
Indigestion 
Dyscrasia (clotting abnormality)
71
Q

True or false, spironolactone can cause gynecomastia?

A

True

Switch to eplerenone if this is the case

72
Q

What is the maximum infusion rate for IV potassium?

A

10 mmol/hr

73
Q

Give two side effects of calcium channel blockers

A

Flushing

Peripheral oedema

74
Q

True or false, metoclopramide makes parkinson’s worse?

75
Q

What are normal replacement fluids?

A

0.9% saline 500ml bolus (STAT)

[If heart failure then 250ml]

76
Q

If a patient is hypernatraemic or hypoglycemic what replacement fluids would you prescribe?

A

5% Dextrose (not 0.9% saline!)

77
Q

If a patient has ascites, would you prescribe 0.9% saline?

A

No. Human Albumin Solution (HAS)

78
Q

What level of urine output is oliguric?

79
Q

What is the rate of maintenance fluids for a healthy adult and an elderly adult?

A

Healthy: 3L/day (8hrly)
Elderly: 2L/day (12hrly)

80
Q

True or false, bendroflumethiazide causes hypokalaemia?

81
Q

If a patient is septic, methotrexate should be stopped, true or false?

82
Q

True or false, metformin is contraindicated in renal failure?

A

True. Metformin is excreted via the kidneys

83
Q

True or false, beta blockers are contraindicated in asthma?

84
Q

What route is insulin almost always given?

A

SC

[Sliding scales are IV]

85
Q

If a patient’s TSH is 0.2, should their levothyroxine dose change?

A

Yes. It should be decreased.

<0.5 - Decrease dose
0.5 - 5 - Keep the same
>5 - Increase dose

86
Q

When is a paracetamol normogram sampled?

A

4 hours after intake

87
Q

True or false, carbamazepine can cause hyponatremia?

88
Q

How do you adjust warfarin if INR is above range?

A

> 8 with bleeding = IV Phytomenadione (Vit K) + Stop
8 no bleeding = Oral Vit K + Stop
5 with bleeding = IV Phytomenadione + Stop
5 no bleeding = Withhold 1-2 warfarin doses and reduce subsequent maintenance doses.

89
Q

What is the treatment for heart failure?

A

[DAB]

Diuretic: Furosemide (Loop diuretic)
ACEi
BB

90
Q

What is the treatment for AF?

A

Haemodynamically stable:
Rate: Atenolol / Diltiazem / Verapamil
Rhythm: Amiodarone / Flecanide

NB: Rhythm control has to be within the first 48 hours or there is a risk of stroke due to clots being released. Rate control is safe even after 48 hours.

91
Q

What is the treatment for bacterial meningitis in primary care and secondary care?

A

Primary: Benzylpenicillin IM
Secondary: Cefotaxime IM / IV

92
Q

What is the first line treatment for PE?

A

LMWH e.g. Tinzaparin

93
Q

What is the first line treatment for a seizure?

A

Lorazepam IV
Diazepam Rectal
Midazolam Buccal

94
Q

What is the treatment for DKA?

A

1 L NaCL 0.9% over 1 hour then over 2hr then 4hr then 8hr. K+ supplementation. Fixed insulin. When BM <14 add dextrose.

95
Q

What is the first line treatment for parkinson’s disease?

A

Levodopa + Carbidopa

[Effective for around 2-5 years].

96
Q

What should be checked when commencing someone on Azathioprine?

A

TPMT activity

97
Q

What is the first line treatment for mild and severe Alzheimer’s?

A

Mild: Acetylcholinesterase inhibitor (rivastigmine, donepezil, galantamine)

Severe: NMDA antagonist e.g. Memantine

98
Q

What is the first line treatment for cellulitis?

A

Flucloxacillin or clarithromycin (if pen allergic)

99
Q

True or false, cyclizine can have antimuscarinic side effects?

A

True

Dry mouth / Constipation / Blurred vision / Urinary retention

100
Q

What is the first line for pain relief in a STEMI?

A

GTN spray or tablet

101
Q

What is a 1% solution?

A

1g in 100ml

102
Q

True or false, Ramipril is safe in pregnancy?

A

False. It is teratogenic.

103
Q

What should patient’s be advised when taking tamoxifen?

A

Risk of VTE and risk of endometrial cancer

104
Q

What should patients taking sulfonylureas be warned about?

A

Don’t skip meals. Risk of hypoglycemia.

105
Q

What do you monitor in a patient taking methotrexate?

A

FBC 1-2 weekly.

Check for neutropenia

106
Q

True or false, citalopram makes you photosensitive?

107
Q

What should patients taking steroids for more than 3 months be given?

A

Bisphosphonates

108
Q

True or false, food should be avoided for 2 hours after taking bisphosphonates as it reduces absorption?

109
Q

What is it important to check when prescribing statins?

A

Liver function as they are metabolised by the liver

110
Q

What is it important to check when prescribing vancomycin?

A

Renal function. It is renally excreted.

111
Q

How often is Lithium checked?

A

Weekly until stable, then every 3 months afterwards.

112
Q

What should be checked when prescribing Olanzapine?

A

Fasting blood glucose. It can cause hyperglycemia

113
Q

What should you check when prescribing COCP?

A

Blood pressure / Pregnancy status / Active cancer / VTE risk

114
Q

What must you check before prescribing digoxin?

A

Renal function. It is renally excreted.

115
Q

What should be monitored when prescribing clozapine?

A

FBC due to risk of neutropenia.

116
Q

What should you check before prescribing sodium valproate?

A

Pregnant/risk of pregnancy

LFTs (hepatotoxic)

117
Q

What should you check before commencing someone on ACEi?

A

Renal function

118
Q

True or false, methotrexate and trimethoprim can be combined safely?

A

False. Bone marrow suppression.

119
Q

True or false, amiodarone can cause pulmonary fibrosis?

120
Q

True or false, erythromycin can increase INR?

121
Q

Do steroids cause hyperglycemia or hypoglycemia?

A

Hyperglycemia

122
Q

True or false, bendroflumethiazide makes gout worse?

123
Q

True or false, COCP is contraindicated in patients with migraine + aura?

124
Q

By what increment should levothyroxine be adjusted?

A

Minimum adjustments, typically 25-50 ug

125
Q

True or false, carbamazepine can cause SIADH?

126
Q

If a patient has renal impairmentand cannot have metformin, what is the first line hypoglycemic?

A

Sulfonylurea e.g. Gliclazide

127
Q

What level of venturi should be first line in COPD?

A

Venturi 24%

128
Q

How often do patients on methotrexate require blood tests?

A

Every 3-4 weeks

129
Q

When should you not give lactulose?

A

If bloating (contraindication)

130
Q

When should you not give a stimulant laxative?

A

If colitis or cramps

131
Q

Why would you not prescribe a bulking agent for fast relief?

A

They take a long time to to work

132
Q

What is the key variable to measure in DKA?

A

Ketone level

133
Q

What is the normal level of vancomycin?

A

Trough level of 10-15 mg/L

No change to meds if in this range

134
Q

At what time should you not rescribe thiazide diuretics?

A

Don’t prescribe them at nightor patient’s will be needing to go to the toilet during the night

135
Q

What is the first line treatment for diarrhoea?

A

Loperamide

136
Q

What is the key side effect of ferrous sulfate?

A

Constipation

137
Q

What is the threshold for blood transfusion?

A

<70g/L

[<100g/L if pre-surgical]

138
Q

How is ferrous sulfate given?

A

Orally until levels normalise and then for another 3 months after

139
Q

What is an alternative antibiotic to use if a patient with pneumonia is allergic to penicillin/amoxicillin?

A

Doxycycline

140
Q

What is the first line for a UC flare up?

A

IV Hydrocortisone if severe

Oral prednisolone if mild

141
Q

In fast AF, what would you give if patient cant have BB?

142
Q

What is the first line for reversal of heparin?

143
Q

How do you reverse hypoglycemia in a conscious patient?

A

15–20 g of fast-acting carbohydrate. This is available in approximately 3–4 heaped teaspoonfuls of sugar dissolved in water, 4–7 glucose tablets, or 150–200 mL of pure fruit juice.

144
Q

What is the max dose of citalopram in over 65s?

145
Q

What must you monitor when giving IV phenytoin?

A

ECG as it is associated with cardiac arrhythmias

146
Q

True or false, thrombolysis is never indicated in DVT?

147
Q

What is the treatment for epiglotitis?

A

Cefotaxime

148
Q

What is the treatment for acute and chronic anal fissures?

A

Acute (<6weeks):

  • Bulk forming laxative (isphagula)
  • Paracetamol/ibuprofen
  • Topical lidocaine

Chronic (>6weeks):
- GTN rectal ointment

149
Q

What route of furosemide is most appropriate in acute pulmonary oedema?

A

IV not oral

150
Q

True or false, Rivaraoxaban is an acceptable form of VTE prophylaxis?

151
Q

What volume/rate is glucose given for hypoglycemia?

A

Glucose 10% 100-200ml over 20mins

Glucose 20% 50-100ml over 20 mins

152
Q

When treating DKA, what do you change about a patient’s short acting and long acting current treatments?

A

Stop short acting e.g. Humulin
Continue long acting e.g. Glargine
Add fixed rate insulin

153
Q

True or false, Tramadol can induce serotonin syndrome?

154
Q

How can you monitor the treatment of congestive heart failure?

A

Weight loss (immediately due to reduced oedema)

155
Q

What is the advantage of oxycodone?

A

Useful if renal impairment

156
Q

True or false, beta blockers are contraindicated in peripheral vascular disease?

157
Q

Give a drug that can exacerbate heart failure

A

Steroids

CCBs

158
Q

Why should you not stop long-term steroids e.g. prednisolone suddenly?

A

Risk of adrenal suppression

159
Q

If glucose control is poor in the evening, how do you correct a patient’s insulin regime?

A

Increase morning biphasic dose.

Long-term changes are better than short term soluble insulin changes.

160
Q

What should you monitor if you start a patient on a potassium sparing diuretic e.g. eplerenone?

A

Potassium levels after 1 week

161
Q

What must you check prior to starting someone on amiodarone?

A

Serum potassium levels

162
Q

True or false, no routine blood monitoring is required for SSRIs?

163
Q

At what level of CK would you stop a statin?

A

> 5x normal upper limit

Stop and restart at lower dose when symptoms resolve

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