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Year 6 - PSA > PSA: Mocks > Flashcards

PSA: Mocks Flashcards

1
Q

List the drugs you stop prior to surgery (7)

A

I LACK OP

Insulin
Lithium
Anticoag/pl
COCP/HRT
K-Sparing Diuretics
Oral Hypoglycaemics
Perindopril/ACEi
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2
Q

Why do you stop metformin before surgery?

A

The NBM predisposes to lactic acidosis

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3
Q

What should you do with pts on insulin prior to surgery?

A

Sliding Scale

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4
Q

How long before surgery do you stop COCP/HRT?

A

4w

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5
Q

How long should you wait before starting the COCP again after surgery?

A

2wks after full mobilisation

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6
Q

How long before surgery do you stop aspirin?

A

7d

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7
Q

How long before surgery do you stop lithium?

A

Day Before

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8
Q

How long before surgery do you stop K-Sparing Diuretics and ACEi?

A

Day of Surgery

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9
Q

What drugs should you NOT stop before surgery?

A 
Antiepileptics
Antiparkinsonian
Antipsychotics
Anxiolytics
Cardiovascular
Bronchodilators
Immunosuppressants
Drugs of Dependence
Thyroid/Antithyroid
Glaucoma
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10
Q

When do you start insulin in NBM pts who were on metformin?

A

If metformin is more than OD or BM >12 on two consecutive occasions

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11
Q

When do you recommence metformin following surgery?

A

The pt is eating/drinking and has normal renal function

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12
Q

How can you maximise the absorption of rivaroxaban?

A

Take w food at the same time each day

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13
Q

Tx of Hypoglycaemia

A

Conscious - Glucotabs x5 PO STAT

No IV Access - Glucagon 1mg IM STAT

Yes IV Access - 10% Dextrose 150mL IV over 15mins

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14
Q

Why is 50% dextrose NOT recommended for use anymore?

A

Risk of extravasation injury and the viscosity makes administration difficult

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15
Q

What is the most common SE of furosemide?

A

Dizziness

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16
Q

What are the UKMEC4 for CHC?

A

Age >=35 AND smoking >=15 cigarettes/day

Postpartum: other VTE RF b/w 0-3wks OR breast feeding b/w 0-6wks

Others: >=160/100 BP, vascular disease, IHD, stroke, AF, VTE, known thrombogenic mutation, positive antiphospholipid abs, major surgery w prolonged immobilisation, migraine w aura, current breast cancer, HCA/HCC, decompensated liver cirrhosis

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17
Q

What should you check before prescribing an OCP?

A

The UKMEC criteria for CHC vs POP

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18
Q

MOA of Salbutamol vs Ipratropium

A

B2 Agonist + Anti-Muscarinic

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19
Q

What is the dose of adrenaline for anaphylaxis in children?

A

150mcg: 1m-5y
300mcg: 6y-11y
500mcg: 12y-17y

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20
Q

How do you write out the dose for adrenaline in anaphylaxis and cardiac arrest in adults?

A

Make sure you specify if 1:1,000 or 1:10,000

Anaphylaxis - IM
0.5mg (0.5mL of 1:1,000)

Cardiac Arrest - IV
1mg (10mL of 1:10,000)

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21
Q

Where is IM adrenaline administered?

A

Into the anterolateral aspect of the middle third of the thigh

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22
Q

What should you offer pts <=84yrs if their QRISK is >=10%?

A

PO Atorvastatin 20mg ON

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23
Q

Which vaccines are pregnant women advised to have?

A

Whooping Cough + Flu

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24
Q

Which vaccines are CI in pregnancy?

A

Live: MMR, chicken pox, yellow fever, BCG, typhoid

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25
Q

What are the common DOACs?

A

Apixaban
Rivaroxaban
Dabigatran

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26
Q

What are the common LMWH’s?

A

Enoxaparin
Dalteparin
Tinzaparin

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27
Q

What are the indications for enoxaparin?

A

Prophylaxis of DVT/PE: mod-sev surgical + medical pts

Tx of DVT/PE: uncomplicated w low risk of reoccurrence, RFs, pregnancy

Tx of MI: acute STEMI +/- PCI, NSTEMI, unstable angina

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28
Q

When is LMWH taken around surgery?

A

At 12hrs pre-op and then every 24hrs following

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29
Q

What is now the first line tx for suspected PE?

A

An anticoag that can be continued once the PE is confirmed: apixaban/rivaroxaban

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30
Q

At which HbA1c is dual therapy advised?

A

> 58 despite max doses of metformin

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31
Q

What is given as fluid resus?

A

0.9% Sodium Chloride 500mL IV over 15mins

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32
Q

When can you give 250mL fluid bolus for resus?

A

Pt w HF to avoid precipitating pulmonary oedema but even then it’s unlikely not to give 500mL

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33
Q

Abx in Pregnancy

A

Safe: penicillin, cefalexin, erythromycin

Avoid: other macrolides, tetracyclines, fluoroquinolones, nitroimidazoles (late preg), trimethoprim (early preg)

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34
Q

Tramadol SEs

A

Agitation + Hallucinations

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35
Q

When should alendronic acid be taken?

A

On an EMPTY stomach ie >30mins before breakfast or another oral medicine and sit upright during this time

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36
Q

Which drugs cause mydriasis?

A

MDMA
Cocaine
Amphetamines

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37
Q

What is used to assess the effectiveness of prednisolone for PMR?

A

The severity of muscle pains

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38
Q

How is the dose of prednisolone reduced for PMR?

A

Start at 15mg OD until sx are fully controlled then 12.5mg 3wks, 10mg 4-6wks and thereafter a reduction of 1mg every 4-8wks until stopped

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39
Q

What should PMR pts seek urgent medical attention?

A

Any sx of temporal arteritis ie unilateral headache, scalp tenderness, jaw claudication, visual disturbance

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40
Q

Adenosine SEs

A

Chest Tightness + Hypotension

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41
Q

Sx of Lithium Toxicity

A 
Diarrhoea
Vomiting
Drowsiness
Tremor
Thirst
Urination
Weakness
Confusion
Ataxia
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42
Q

How do ACEi cause hyperK?

A

Dec Angiotensin II
Dec Aldosterone
Dec Na + Inc K

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43
Q

HyperK ECG

A
  1. Peaked T Waves
  2. Small P Waves
  3. Inc PR Interval
  4. Broad QRS
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44
Q

What should you add to maintenance fluids?

A

KCl

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45
Q

What are the normal daily fluid and electrolyte requirements?

A

25-30 ml/kg/d H2O

1 mmol/kg/d Na, K, Cl

50-100 g/day Glucose

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46
Q

What is the best way to specify the type of preparation of miconazole?

A

Prescribe ‘Miconazole Gel/Cream/Spray’

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47
Q

When should pts on carbimazole seek immediate medical advice?

A

Any fevers/sore throat to check for agranulocytosis

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48
Q

Precipitates Hyperglycaemia

A

Glucocorticoids

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49
Q

Precipitates Hyperlipidaemia

A

Thiazide Diuretics

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50
Q

Aminoglycosides

A 
Gentamicin
Amikacin
Tobramycin
Streptomycin
Neomycin
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51
Q

Fluoroquinolones

A

Ciprofloxacin
Levofloxacin
Moxifloxacin

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52
Q

What is used to assess the effectiveness of abx for CAP?

A

CRP: changes more rapidly than ESR/WCC

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53
Q

Tx of Status Epilepticus

A

Once only of either:

Diazepam 10mg Rectal
Midazolam 10mg Buccal
Lorazepam 4mg Intravenous

Repeat @ 10-20mins if no response

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54
Q

IV Paracetamol Dosing

A

<50kg: 15mg/kg every 4-6hrs over 15mins w max 60mg/kg/d

> =50kg: 1g every 4-6hrs over 15mins w max 4g/d

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55
Q

What is the first line tx of HTN in pregnancy w/o asthma?

A

Labetalol

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56
Q

Analgesia + Alcoholic Liver Disease

A

Avoid NSAIDs (risk of bleeding) and opioids (hepatic encephalopathy)

57
Q

RFs for Drug-Induced Psoriasis

A 
Obesity
Diabetes
Hypertension
Dyslipidaemia
Smoking
58
Q

What is the acceptable range of blood glucose for a type 1 diabetic pre-op?

A

4-12mmol/L

59
Q

What is the general guide to giving supplementary doses of insulin?

A

If you can’t ask the pt use 100/TDD or that one unit will roughly drop blood glucose by 3mmol/L

60
Q

What would be the indication to postpone surgery in a pt w T1DM?

A

Blood Glucose >=12mmol/L

And: capillary blood ketones >3 or urinary ketones >+++

61
Q

Tx of HyperCa

A

0.9% Sodium Chloride 1L IVI over 1hr + then recheck the calcium after

62
Q

Morning Sickness vs Hyperemesis

A

None of: >5% wt loss, dehydration, electrolyte imbalances

63
Q

Tx of Hyperemesis in Early Preg

A

Antiemetics +/- Fluids

  1. Oral/IM Antihistamine eg Cyclizine/Promethazine
  2. Oral Metoclopramide/Ondansetron
64
Q

What is the usual dose of atenolol for HTN/angina?

A

25-100mg

65
Q

Precipitates Hypoglycaemia

A

Thiazolidinedione eg Pioglitazone/Rosiglitazone

66
Q

Statins + Warfarin

A

Inc INR by competitive inhibition of CYP-450 metabolism

Monitor: Simvastatin/Atrovastatin

Avoid: Fluvastatin/Rosuvastatin

67
Q

List the abx that should NOT be mixed with alcohol (4)

A

Metronidazole
Tinidazole
Sulfamethoxazole
Trimethoprim

68
Q

When would a dose of 5mg > 400mcg folic acid by required during first 12wks of pregnancy?

A

If at high risk of conceiving a child with a neural tube defect: prev infant w defect, on anti-epileptics, has diabetics/sickle cell disease

69
Q

Antihistamines: Sedating vs Non-Sedating

A

Sedating: chlorphenamine, hydroxyzine, promethazine

Non-Sedating: cetirizine, fexofenadine, loratadine

70
Q

Tx of Uncomplicated Chlamydia

A
  1. PO Doxycyline 100mg BD 7d

2. PO Azithromycin 1g x1

71
Q

Tx of Uncomplicated Gonorrhoea

A
  1. IM Ceftriaxone 1g x1

2. PO Ciprofloxacin 500mg x1

72
Q

Tx of Scabies

A
  1. Apply topical permethrin 5% cream given as two applications 7d apart and washed off after 8-12 hrs
  2. Add oral ivermectin 200mcg/kg if hyperkeratotic or failure to respond to first line topical tx alone
73
Q

Tx of Reflux in Infants

A

Breastfed:

  1. Breastfeeding Assessment
  2. Trial 1-2wk Gaviscon Infant

Formula:

  1. Review Feeding Hx
  2. Trial Dec Amount Inc Freq
  3. Trial Thickened Formula
  4. Trial 1-2wk Gaviscon Infant

Medical:
Trial 4wk Omeprazole/Ramitidine

Sugical:
Nissen Fundoplication

74
Q

Tx of OAB

A

Oxybutynin Hydrochloride Immediate-Release

75
Q

What should you specify when prescribing oramorph PRN?

A

Set a time limit eg 4hrly

76
Q

What should you put as the dose for permethrin 5% cream?

A

‘1 application topical once a week’

77
Q

SSRI + Triptans

A

Serotonin Syndrome

78
Q

Which class of oral hypoglycaemics inc risk of UTI?

A

Gliflozins

79
Q

CCB SE

A

Leg Swelling

80
Q

Px of Impetigo

A

Child w several pustulated areas on the face which form a yellow crusted lesion when they burst

81
Q

Tx of Impetigo

A

All one application to the skin three times a day for 5d:

  1. Topical Hydrogen Peroxide 1% Cream
  2. Topical Fusidic Acid 2% Cream
  3. Topical Mupirocin 2% Cream
82
Q

When do you use oral vs IV rehydration in children?

A

Preferable to use ORS even if hypernatremic unless:

  • Shock (different parameters inc HR/RR and dec BP than adults)
  • Red Flags (sunken eyes, red skin turgor, unresponsive)
  • Persistently vomits the ORS
83
Q

When do you half the starting dose of allopurinol? (2)

A

Elderly or Hepatic Impairment

84
Q

Clozapine SE

A

Agranulocytosis

85
Q

How do you monitor clozapine?

A

Differential WBC wkly for 18wks - fortnightly for 1yr

86
Q

How do you monitor NOACs?

A

Not routinely as unreliable BUT for active bleeding

87
Q

Tx of Mastitis

A

If infected nipple fissure, sx not improving after 12hrs despite effective milk removal, pos culture:

  1. Flucloxacillin 500mg Oral QDS
  2. Erythromycin 500mg Oral QDS
88
Q

What should be monitored prior to and then annually after commencing the COCP?

A

BP + BMI

89
Q

Tx of Variceal Upper GI Bleeding: Before Endoscopy

A

A-E + IV Terlipressin 2mg every 4hrs

90
Q

Tx of Non-Variceal Upper GI Bleeding: After Endoscopy

A

A-E + IV Omeprazole 80mg over 1hr

91
Q

When should you NOT prescribe hypnotics?

A

Routinely they’re for the acutely distressed

Elderly/Pregnant/Breastfeeding

92
Q

How do you induce a withdrawal bleed in a woman w prolonged amenorrhea ie less than one period every 3m?

A

Prescribe a cyclical progestogen and refer for a TVUS to assess endometrial thickness: medroxyprogesterone acetate 10mg oral once a day

93
Q

Tx of IDA

A
  1. Ferrous Sulphate 200mg TDS

2. Ferrous Gluconate 300mg QDS

94
Q

Tx of Opioid Dependence

A
  1. Buprenorphine 4mg SL OD

2. Methadone 10mg PO OD

95
Q

What are the different types of laxatives?

A

Osmotic: Lactulose + Movicol

Stimulant: Senna + Picolax

Bulk Agents: Ispaghula Husk + Methylcellulose

Stool Softeners: Docusate Sodium + Arachis Oil

96
Q

Which type of laxative should be used in pts w anal fissures?

A

Lactulose

97
Q

Which type of laxative should be used in pts w haemorrhoids?

A

Ispaghula Husk

98
Q

When should alendronic acid be stopped?

A

After 10yrs where mx should be taken on a case-by-case basis

99
Q

Tx of Hyperthyroidism

A
  1. Propranolol

2. Carbimazole (or propylthiouracil if pregnant)

100
Q

COCP

A

Microgynon 30 One Tablet PO Daily

101
Q

POP

A

Cerazette 75mcg PO Daily

102
Q

Tx of Bell’s Palsy

A

If px within 72h give pred

103
Q

Which heparin should you give to renal failure pts?

A

Unfractionated

104
Q

Tx for Chemotherapy Related N+V

A

Low risk of sx then metoclopramide vs high risk of sx then ondansetron

105
Q

When would you seek expert help during fluid resus?

A

> 2000mL given OR pt is in shock

106
Q

When are NG fluids or enteral feeding preferred?

A

When maintenance needs are more than 3 days

107
Q

When would you consider prescribing less maintenance fluids i.e. 20-25mL/kg/day?

A

Older/frail, cardiac failure, renal impairment, malnourished, risk of refeeding syndrome

108
Q

How do you quickly navigate the BNF and CKS?

A

BNF - click on the prefill dropbox do NOT type the drug in full and press return

CKS - pick the letter and control F do NOT search for the condition

109
Q

Which type of monitoring qs can you find in the BNF?

A

Only drug toxicity NOT efficacy

110
Q

Why shouldn’t you go on prescribing information in CKS?

A

The info we’ll need for the qs requiring CKS will be in mx

111
Q

What are the CIs to all penicillins?

A

If it’s a LT infection give penicillin unless prev anaphylaxis

But for all other infections use an alternative if there’s any hx of a rash

112
Q

Which other class of abx may a pt w penicillin allergy react to?

A

Cephalosporins

113
Q

Tx of Meningitis

A

GP: IM Benzyl Penicillin

Hosp: IV Co-Trimoxazole

114
Q

What should you do if you’d advise more than one option?

A

Pick the life saving one

115
Q

When would pioglitazone or gliclazide NOT be appropriate?

A

Pioglitazone: high risk of bladder cancer

Gliclazide: elevated BMI

116
Q

Tx of Chronic Asthma

A
  1. SABA
  2. SABA + Low ICS
  3. SABA + Low ICS + LTRA
  4. SABA + Low ICS + LABA +/- LTRA
  5. SABA + Low MART +/- LTRA
  6. SABA + Med MART +/- LTRA
  7. Inc MART Dose or Add Aminophylline
117
Q

Tx of Long-Term COPD

A
  1. SABA + SAMA
  2. If signs of asthma or good steroid response: no add LABA+LAMA OR yes add LABA+ICS
  3. SABA + LABA + LAMA + ICS
118
Q

Tx of Chronic HTN

A

<55yrs / T2DM: ACEi/ARB

> 55yrs / Afro-Caribbean: CCB

Then add the other one/thiazide on before taking all three

119
Q

Tx of Renal Calculus

A

Diclofenac

120
Q

Topical Corticosteroids

A

Mild: hydrocortisone 0.1-2.5% cream

Mod: clobetasone butyrate 0.05% cream

Potent: diflucortolone valerate 0.1% cream

V Potent: clobetasol propionate 0.5% cream

121
Q

Prophylaxis/Tx of Infected Dog/Cat Bite

A

Co-Amoxiclav

122
Q

Tx of PCP

A

Co-Trimoxazole

123
Q

Tx of Acute Otitis Media

A

Paracetamol
Ibuprofen
Amoxicillin

124
Q

Tx of Pityriasis Versicolor

A

Ketoconazole

125
Q

Tx of Strep Pneumoniae CAP

A

Tazocin + Meropenem

126
Q

Tx of Lyme Disease

A

Oral doxycycline unless CNS involvement therefore IV ceftriaxone is used

127
Q

Tx of BV

A
  1. PO Metronidazole

2. Topical Clindamycin

128
Q

Tx of AD

A
  1. Donepezil

2. Memantine

129
Q

Who is at high risk of refeeding syndrome?

A

Lost >15% BW within the last 3-6m

Little/no nutritional intake for >5d

130
Q

What is the most important abnormality to correct in refeeding syndrome?

A

Phosphate Polyfusor 50mL IV Over 12hrs

131
Q

Which anaemia can aspirin cause?

A

IDA

132
Q

Urinary Retention

A 
Anticholinergics
Alpha Agonists
Antihistamines
Alcohol
Benzos
CCBs
NSAIDs
GA
133
Q

What is HRT a/w?

A

Inc risk of breast cancer

134
Q

Why is oestrogen only hrt NOT given to women with an intact uterus?

A

Inc risk of endometrial cancer

135
Q

When should you stop HRT?

A

> 160/95 BP

136
Q

At which level of serum transaminases should prompt the discontinuation of statin therapy?

A

> 3x Upper Limit

137
Q

At what fentanyl level can pts use nasal for breakthrough pain?

A

25mcg

138
Q

Nasal Fentanyl Spray

A

Max 50mcg into one nostril, repeat in 10mins, wait another 4hrs

Year 6 - PSA (4 decks)

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