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1
Q

Fibromyalgia- first line med

A

Amitriptyline
Avoid opioid analgesia
Rreassurance and regular aerobic exercise

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2
Q

Does the lancet think in acute back pain there is difference between panadol and placebo?

A

No

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3
Q

Compare terms hyperaesthesia, dysaesthesia, paraesthesia, hyperalgesia, allodynia, hyperpathia

A

hyperaesthesia is increased sensation to stimulus (subgroups hyperalgesia, allodynia, hyperpathia)

parasthesia not unpleasant abnormal
dysaesthesia unpleasant abnormal

hyperalgesia- painful stimulus but extra pain
allodynia- pain from non painful stimulus
hyperpathia - pain from reped stimulus

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4
Q

Describe codeine metabolism

A

Codeine is metabolised to morpine via CYP 2D6
May be absent in 10% caucasians
Can be uptrarapid metaboliser with +++ effect

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5
Q

What is the effect of tramadol?

A

serotonin and noradrenaline reuptake inhibitor and mu opioid agonist

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6
Q

How does tapentadol work/compare?

A

Mu opioid but weaker than morphine
NA reuptake inhibition
Better GI tolerability than oxxy
Cannot give with MAOi

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7
Q

What is NNT for targin and constipation

A

NNT if already opiod const = 4

NNT otherwise = 14

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8
Q

What is a 25 mcg/hr fent patch in morphine per day

A

90mg/day morphine

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9
Q

Gabapentin target and pregabalin target?

A

alpha-2-delta subunit of calcium channels in brain and dorsal horn

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10
Q

trigeminal neuralgia first line

A

carbamazepine

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11
Q

painful diabetic neuropathy first line

A

duloxetine

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12
Q

Post herpetic neuralgia first line

A

pregab or gabapentin or TCA

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13
Q

Secondary causes of increased LDL

A

hypothyroidism
nephrotic syndrome
cholestasis
anorexia

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14
Q

Causes of increase TAG AND HDLs

A

Oestrogen use

Alcohol

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15
Q

Causes of increase TAG and HDL decrease

A

type 2 DM
obesity
renal imp
smoking

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16
Q

Effect of fish oil on lipid profile

A

reduce TAG

no change LDL

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17
Q

First line in LDL predominant

A

statin

ezetimibe second line

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18
Q

Effect bile acid binding resin on TAG

A

increase

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19
Q

What is the risk of statin plus nicotinic acid?

A

Increase risk rhabdo

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20
Q

Which fibrate should you not combine with a statin?

A

Gemfibrozil

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21
Q

TAG increase- first lineq

A

Fenofibrate or gemfibrozil
Or fish oil
NOT ok to use statin monotherapy

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22
Q

What do you use first line if both LDL and TAG are up?

A

If TAG under 4 total then use statin

If over 4 then use fibrate first line

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23
Q

What should your CK cutoff be?

A

tolerate up to 5 times ULN, mild muscle sx
Tolerate up to 3 x ALT LN

Also if asympt and up, should repeat after 7 exercise free days.

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24
Q

If CK stays up after stop a statin, what should you do?

A

Consider hypothyroidism or NM disease

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25
Q

Does statin cause diabetes

A

can impair glucose metabolism

sort of 1 in 1000

26
Q

Fibrate effect on kidney

A

increase creatinine but no kidney effect; ok up to 30mmol or 30%

27
Q

What is the MOA of oxybutynin?

A

Inhibits M2 and M3 receptors in bladder to stop muscarinic ACh action –>antispasmodic
No antinicotinic effects
Avoid in GI obst, narrow angle glaucoma, GORD

28
Q

Which type of incontinence can you use oxybutynin?

A

Urge incontinence

29
Q

What are the other types of antispasmodics, and how are they classified

A

There are nonselective antimuscarinics which act on M2 and M3 receptors eg oxybutynin and tolterodine. Can cross BBB to lead to less dizziness and cog symptoms

There are M3 selective eg solifenacin. Cannot easily cross BBB- M3 selective, increase risk dry mouth at higher dose. Safer if over 65

30
Q

If person who is 30 has spleen out, how to pneumovax 23 them?

A

Give 30, 35 and then at 65

31
Q

If person who is 66 has spleen out, how to pneumovax?

A

Give at 66, then 71

32
Q

If completely healthy caucasian 65 year old, how to pneumovaz?

A

Single dose at 65

33
Q

How do ATSI rules differ for pneumovax?

A

The same except age 50 cutoff and revaccinate everyone twice

34
Q

Are obesity, down sydrome and alcoholism considered Flu refundable?

A

No

35
Q

EEG in delirium?

A

Background slowing

36
Q

What is thought to be the brain imbalance in delirium?

A

Cholinergic deficiency and dopaminergic excess

37
Q

Leading RF for delirium?

A

Dementia

38
Q

what is tricky about DLB and dlirium

A

Both have fluctuating cognition and visual hallucinations

39
Q

What is the drug of choice in delirium short term?

A

Haloperidol
-be aware of extrapyramidal effects, long QT

Quetiapine associated with increased death rates among dementia

Benzos- worsen delirium

40
Q

What stroke can present as a delirium?

A

Right parietal and medial dorsal thalamus

41
Q

paget’s most common location

A

pelvis >femur>lumabr>skull>tibia

42
Q

What is the mutation in 5-10% sporadic paget’s?

A

SQSTM1 mutation- encodes p62 which regulates osteoclass

43
Q

What is the biochemical finding in paget’s?

A

Increase ALP

hypercalcaemia if immobilised

44
Q

Skull pagets can lead to…

A

deafness

45
Q

Radiograph of pagets

A

focal osteolysis with coarse trabecular pattern, bone expansion, cortical thickening

cotton wool appearance of skull

RADIONUCLEOTIDE BONE SCAN MOST USEFUL

46
Q

Do you treat pagets?

A

If pain–>antiresorptive
If no pain–>no indication to treat
If pain at pseudofracture site–> surgery

47
Q

If you cannot use bisphosphonates in pagets due to renal impairment, what could you use?

A

Calcitonin

48
Q

Aboriginal with paget’s?

A

No! They don’t get it!

49
Q

Complications of paget’s?

A

Sarcoma rare
pain and deformity
spinal cord stenosis
patholgical fracture
nerve root compression
CN- ophthalmoplegia, facial and bulbar palsy, trigeminal neuralgia
hearing loss from temporal bone involvement

50
Q

Increase Ca and increase ALP
vs
Decrease Ca and increase ALP

A

mets, HPT

osteomalacia, renal failure

51
Q

Which is worse for falls risk? Psychoactive or antihypertensive?

A

Psychoactive

Also 4 or more medications

52
Q

How many times a year to fall to prevent one warfarin serious bleed?

A

300

53
Q

What effect does delay to theatre have on hip fracture?

A

Double mortality with operative delay over 2 days

54
Q

Hip fracture patients - how many never get home?

A

20% never get home

30% dead at one year

55
Q

Most common form of incontinence in the elderly?

A

Urge and mixed urge/stress

56
Q

Effect of anticholinergics on voiding

A

Reduced flow rate and increased residual colume

57
Q

Cholinergics effect on incontinence

A

Cholinergics may precipitate or worsen urge symptoms and incontinence

58
Q

What do calcium channel blockers do to your gut?

A

constipating (smooth muscle)

59
Q

First line for stress incontinence?

A

Pelvic floor exervises
Topical oestrogens can help with urethral atrophy
NOT HRT
Mid urethral sling last line- may make it worse so need urodynamics to rule out detrusor instability

60
Q

Treatment for urge incontinence in cognitively intact?

A

Antimuscarinic (oxybutynin, solifenacin, tolteridone, darifenacin) - but peripheral anticholinergic effects

61
Q

What is material risk?

A

Telling the patient about a risk that would change the PATIENT’s mind about an intervention

62
Q

Can you refuse palliative treatment as next of kin?

A

No
Can refuse medical care but not palliative care
Palliative treatment includes reasonable provision of food and water but PEG feeding is medical treatment

Geriatrics (8 decks)

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