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A final year of medicine > PSA PastTest > Flashcards

PSA PastTest Flashcards

1
Q

Thyroxine in pregnancy?

A

Only very small amount crosses placenta and is therefore very safe; check TFTs in every trimester and 4-5 weeks after each dose change. Starting dose is around 100mcg daily

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2
Q

Four stimulant laxatives?

A

Bisacodyl, senna, docusate, glycerol suppositories

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3
Q

Max inhaled steroid dose for asthma in adults?

A

2000mcg a day

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4
Q

What are the conditions for controlled asthma?

A

No daytime symptoms or nocturnal awakening due to asthma, no use of rescue/reliever medications, no acute asthma attacks/exacerbations, no limitation of activity/exercise, normal lung function (FEV1/PEF>80% predicted/best), and few side effects from medications

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5
Q

Management of patients with an INR of 5-8 and not bleeding?

A

Withhold 1-2 doses of warfarin and reduce maintenance dose

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6
Q

Management of patients with INR of 5-8 with minor bleeding?

A

If minor bleeding, stop warfarin, give IV vitamin K, restart warfarin when INR <5

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7
Q

Management of patients with INR >8 and no/minor bleeding?

A

1-5mg oral vit K if no bleeding, or slow IV vit K injection if minor bleeding

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8
Q

Treating IDA in pregnancy?

A

If at risk, give prophylactic dose of ferrous sulphate, 200mg OD

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9
Q

Initial management for pericardial chest pain?

A

NSAIDs, usually ibuprofen

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10
Q

Monitoring of patients on hydroxychloroquine?

A

Chronic use can cause toxicity in the eye; all patients on long-term treatment should have baseline examination of eyes after 6-12 months. May be used for SLE etc.

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11
Q

Ondansetron in pregnancy?

A

Crosses placenta in first TM and may be associated with adverse fetal events so is reserved for severe HG or when conventional treatments have failed

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12
Q

Nitrofurantoin in low EGFR?

A

Contraindicated in EGFR <45 dye to systemic accumulation

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13
Q

Gentamicin toxicity features?

A

Is an aminoglycoside; nephrotoxic, ototoxic and can cause NM blockade. Ototoxicity in this case can present with vertigo, nausea, vomiting, ataxia, dizziness (i.e. vestibular symptoms) or cochlear symptoms (namely tinnitus and hearing loss). Often irreversible.

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14
Q

Calpol and neurofen in infants?

A

Can be used in infants but not recommended under 3 months unless prescribed by a doctor

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15
Q

Treating malaria?

A

Proguanil with atovaquone (Malarone)

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16
Q

Medical treatment for Conn’s (hypokalaemia and hypertension)?

A

Spironolactone

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17
Q

High dose folic acid regime in pregnancy?

A

5mg daily until 12 weeks pregnant

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18
Q

Memantine indication and side effects?

A

NMDA antagonist; used in moderate-severe Alzheimers. Side effects include constipation, drowsiness, headahe, hypertension

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19
Q

Treatment of tonsillitis in childhood?

A

Give Penicillin V if unwell

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20
Q

Pro-methazine indications and SEs?

A

Anti-histamine (used for dust and pollen allergy); is older generation so likely to cause sedation

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21
Q

If have patient with bradycardia and postural hypotension on furosemide, losartan and bisoprolol, which two would you stop first?

A

Furosemide and bisoprolol

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22
Q

Correct monitoring for methotrexate (for RA)?

A

Fortnightly LFT, FBC, U&Es until stabilised, then every 2-3 months

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23
Q

Most common side effects of methotrexate?

A

Hepatotixicity, ulcerative stomatitis, bone marrow suppression

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24
Q

How does venlafaxine work?

A

SNRI (serotonin-NE reuptake inhibitor)

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25
Drugs at high risk and moderate risk of falls?
High - anti-muscarinics, antidepressants, anti-psychotics, dopaminergic drugs; moderate - opiates, ACE inhibitors, diuretics, anti-histamines
26
Treating syphilis?
Benzathine penicillin G IM
27
Signs warranting hospital admission in E of COPD?
Inability to cope at home, rapid onset of symptoms, severe dyspnoea, hypercarbia and hypoxia, poor premorbid state/receiving LTOT, CXR signs, ABG showing acidosis or P02 <7
28
Using nebulisers in COPD patients with acidosis or hypercapnia?
Should use air-driven rather than 02 driven
29
When is human albumin solution used?
As fluid replacement during significant volume paracentesis. Commonly use 20% preparation (100ml after every 3L drained)
30
Adverse effects of carbamazepine in pregnancy?
Teratogenicity (NTDs, hypospadias, craniofacial and CV malformations), and haemorrhagic disease of the newborn
31
Drugs causing hypothyroidism (ADD TO)?
Lithium, amiodarone (can cause hypo- or hyper-)
32
Drug for prophylaxis of TB?
Isoniazid
33
SSRIs and bleeding?
Cause increased bleeding risk, especially in older people
34
Monitoring on clozapine?
Risk of agranulocytosis; FBC weekly for first 18 weeks, then 2-weekly then 4-weekly
35
Drugs causing tocolysis?
Nifedipine, terbutaline, GTN, atosiban
36
Treating impetigo?
Flucloxacillin
37
Most appropriate therapy before OGD in variceal bleed?
IV terlipressin (potent vasoconstrictor of splanchnic circulation, can also cause cardiac arrhythmias)
38
When should digoxin therapeutic range be assessed?
6-12 h post dose. Get steady state in 7-10 days.
39
Fluid for DKA when K+ is above 5.5?
0.9% saline with no added potassium
40
Diclofenac and liver?
Diclofenac induced liver injury is most commonly seen in elderly female patients and therefore drug used with caution in these patients; abnormal LFTs may be transient or progress
41
Side effects of phenytoin?
Coarsening of facial features, acne, hirsutim, gingival hyperplasia, facial oedema
42
Thyroxine dose changes?
In absence of frank toxicity, increase or decrease doses at 25-50 microgram intervals then recheck TFTs at 2-4 weeks
43
Dosing in metformin?
Should not take double dose is miss a dose.
44
Metformin and weight gain?
Metformin can cause weight loss in the obese
45
Side effects of pergolide?
Dopamine receptor agonist; associated with cardiac fibrosis (contra-indicated in heart valve disease), delusions, diplopia, dyspnoea, dyspepsia
46
Why is Hartmann's inappropriate for resusc?
Contains lactate; lactate metabolism generates bicarbonate and therefore can cause metabolic alkalosis
47
Most important blood test before starting statins?
LFTs; contra-indicated in patients with grossly abnormal LFTs. Statins cause 1% occurence of LFT elevation in first three months. Can also check CK if patient at risk of myopathy
48
What should patient do if miss warfarin dose?
If realise within 12 hours of original dose time, should take usual dose. If too late, then just take normal dose at normal time for next dose (do not double dose)
49
Worrying side effect of bleomycin?
Lung fibrosis
50
Infliximab side effect?
Activation of latent tuberculosis
51
Why is IV dextrose bad for resusc?
Dextrose quickly metabolised leaving water which leaks through capillary beds and causes pulmonary oedema
52
Which patients with stage 1 HTN get offered pharmacological treatment?
Those with target organ damage, diabetes, 10-year CV risk of greater or equal to 20%, or established CVD
53
Gliclazide information?
Works by stimulating insulin release (and increasing insulin sensitivity) so can get hypoglycaemia, weight gain. Often GI side effects. Taken with meals, usually BD.
54
Side effects of entacapone?
COMT inhibitor; works by decreasing L-dopa metabolism. Get orthostatic hypotension, hallucinations, dyskinesia, red-brown urine, dry mouth.
55
NSAIDs and bronchospasm?
A rare side effect, so can be used with caution in asthmatics
56
When should COC be avoided re FHx?
If have first degree relative with history of VTE under 45
57
Pregnant patients with various BMs?
If fasting BG >7, start insulin immediately (with or without metformin) and diet/exercise. If <7, diet and exercise programme is first-line (then add metformin, and then insulin)
58
Treating SVT?
Adenosine is first-line; should not be used in patients with reactive airway disease
59
Taking statins and clarithromycin?
If starting patient on clarithromycin, statins should be stopped temporarily as clarithromycin is inhibitor and can cause toxicity
60
Statins at certain times of day?
Atorvastatin at any time of da, simvastatin in evening
61
When is potassium added in DKA management and how much?
When gets between 2.5-5.5, use 0.9% saline (1L) with 40mmol/L of KCl
62
Best drug for post-operative nausea and vomiting?
Cyclizine; metoclopramide limited efficacy
63
ACEI in pregnancy?
Associated with oligohydramnios, anuria, hypotension, renal failure, skull hypoplasia and fetal death
64
Four drugs for severe/life-threatening asthma?
Salbutamol and ipratropium nebs, oral steroids, IV MgSO4
65
Hormonal contraception for breast cancer patients?
Patients with active breast cancer, or who have had breast cancer within the last five years, should not be on hormonal treatment (copper IUD best)
66
Amiodarone and LFTs?
Can cause hepatitis, so do baseline LFT and repeat on 6 monthly basis for duration of treatment
67
Maximum rate of potassium infusion peripheraly?
10mmol/hour, so if have 40mmol in 1L then can give over four hours. If severe hypokalaemia (espec. with cardiac compromise), give rapid KCl infusion via central line
68
Lithium and hypothyroidism?
Five-fold increased risk, hence thyroid function testing every 6 months
69
Lithium and renal monitoring?
As is renally excreted, should be checking U&E every six months
70
When to check lithium levels?
12 hours post-dose. Should be checked three monthly (more frequently in first month)
71
Amiodarone and warfarin?
Amiodarone is inhibitor so increases INR
72
Side effects of levo-dopa?
Nausea, somnolence, dizziness, headache (common). More serious include confusion, hallucinations, delusions, agitation, psychosis, orthostatic hypotension
73
First-line rate control treatment for AF without HF?
B-blocker or CCB (rate-limiting)
74
Relieving nausea and vomiting in patients with mechanical bowel obstruction?
Large bore NG tube to decompress; drug therapies e.g. cyclizine not effective in these patients.
75
Metoclopramide in bowel obstruction?
Should not be used at all as is a pro-kinetic
76
Firstline treatments for neuropathic pain?
Amitriptylline, gabapentin, pregabalin and duloxetine
77
Cross-tapering from SSRIs to TCAs?
Safe in all but fluoxetine to amitriptylline
78
Treating hyperphosphataemia in CKD?
Get phosphate retention as less is filtered. If remains high despite dietary restriction, treat with phosphate binders. If hypocalcaemic too, use calcium-containing phosphate binders e.g. CaCO3 or calcium acetate
79
Taking folic acid with methotrexate?
Usually taken on a different day to the methotrexate
80
Monitoring in azathioprine?
Initially monitor FBC, U&E, LFTs weekly for first four weeks, then every 3 months
81
Reducing frequency of sickle cell crises?
Hydroxycarbamide can be used. Increases production of fetal haemoglobin and decreases Hb polymerisation. Only used in patients with frequent exacerbations.
82
Diuretics and lithium?
Diuretics are common precipitants of lithium toxicity
83
Monitoring BP on patients on COC?
Important because if have CVD inc. HT then increased risk
84
Osmotic laxatives include?
Lactulose (stimulant too), sodium salts, phosphate enema, magnesium hydroxide
85
Treating TGN?
Carbamazepine, lamotrigine, phenytoin, gabapentin
86
First litre of fluid in DKA patients who are not SBP <90?
1L 0.9% NaCl over one hour
87
Tacrolimus dose monitoring?
Must do pre-dose trough level (immediately before morning dose) as high levels give side effects
88
Ciclosporin monitoring?
Fortnightly monitoring of FBC, U&E, LFTs, baseline and periodic lipids, then monthly after 6 weeks of stable dose, then after 12 months of stable dose can do 3 monthly
89
Key blood to decide vancomycin dosing?
Serum creatinine; is renally excreted and overdose is nephrotoxic, ototoxic and neurotoxic
90
Drug to lower portal hypertension?
Propanolol
91
Efficacy of dabigatran vs warfarin?
Higher dose of dabigatran (150mg BD) is more effective for stroke prevention in AF (but higher bleeding risk), lower dose (110mg BD) is as effective
92
Dabigatran clearance?
80% renally excreted so must monitor renal function annually
93
Phenytoin monitoring?
Should use pre-dose (trough) levels. Dose and plasma concentration non-linear so small dose changes can have large effects.
94
Opiates in renal impairment?
Fentanyl mainly hepatic metabolised so safer in renally impaired patients
95
Bloods after starting olanzapine?
Can cause hyperglycaemia and DM so check BG
96
PPIs in pregnancy?
Lansoprazole in pregnancy is avoided, omeprazole not known to be harmful
97
Abx for early-onset (first 5 days of admission) HAP?
Co-amoxiclav
98
Loop diuretics and bones?
Increase calcium excretion which can lead to thinning bones. Thiazides are protective, however
99
PPIs and bones?
Can increase risk of bone loss and fractures when used at high doses for more than a year
100
Treating localised impetigo?
Give topical fusidic acid
101
Drugs most likely to cause erythema multiforme?
Anticonvulsants, antibiotics, aspirin
102
Alcohol and hypoglycaemia?
Alcohol can cause hypoglycaemia (promotes insulin release)
103
What to do in paeds seizures that have continued despite two doses of benzos?
IV phenytoin (or phenobarbital if already on phenytoin)
104
First and second line prognostic treatments for CHF?
Firstline is ACEI and B-blocker; second-line is to add in aldosterone antagonist e.g. spironoactone, ARB, or hydralazine with nitrate
105
First line antibiotics for uncomplicated UTI?
Trimethoprim and nitrofurantoin
106
Folic acid dose?
400mcg daily for pregnant women with low NTD risk, 5mg weekly alongside methotrexate, 5mg daily for high-risk women in pregnancy
107
What to do if miss clozapine dose?
If more than 48 hours or more between dose, retitration must start at 12.5mg (lowest dose) because of severe hypotensive effects
108
Side effects of clozapine?
Agranulocytosis, myocarditis, reduced seizure threshold; also hypersalivation, hypotension, tachycardia and weight gain
109
Smoking and clozapine?
As cigarette smoking is an inducer, stopping smoking can increase clozapine levels dramatically
110
Two aspirin doses?
75mg OD for IHD etc; 300mg reserved for ACS etc.
111
Standard salbutamol dose?
2 puffs PRN
112
Insulins for DKA?
Actraid or Humulin S
113
Codeine in breastfeeding?
Not recommended, as mother's ability to metabolise it varies greatly
114
Atorvastatin dose post-MI?
80mg daily (secondary prevention dose); otherwise 20mg daily
115
Firstline treatment of infective conjunctivitis?
Chloramphenicol drops 0.5%

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