Random Questions from Practice Papers Flashcards
What drug class of antidepressants are most likely to cause antimuscarinic side effects?
Tricyclic antidepressants e.g. dosulepin, clomipramine
What is Von Willebrand disease?
A genetic disease in which clotting factors are reduced, leading to a prolonged INR
Which beta blocker can be used for thyrotoxicosis?
Propranolol
It reduces symptoms of hyperthyroidism caused by an increase in beta-adrenergic tone e.g. palpitations, anxiety
Which drug class of antidiabetics can cause acute pancreatitis?
GLP-1 receptor agonists (-glutide)
What medicines can be used as first-line therapy for lewy-body dementia?
Donepezil
Rivastigmine
Which anticoagulant should be taken with food?
Rivaroxaban
What type of CCB should not be given to patients with heart failure with reduced EF? Why?
Rate-limiting (e.g. verapamil) and short-acting (e.g. nifedipine)
Can cause reduced cardiac contractibility
What is the mechanism of action of loperamide?
Inhibits μ-opioid receptors in the gut, reducing peristalsis
What commonly used drug can be used to reduce stoma output?
Omeprazole (reduces stomach acid secretion)
What type of insulin is fast-acting?
Soluble insulin (15-30 min onset)
What type of insulin should be reserved for medical emergencies (e.g. DKA)?
IV soluble insulin
What are examples of rapid-acting insulin?
Aspart
Glulisine
Lispro
How should metformin be dosed initially?
Titrated up (increase freq. every week) to minimise GI side effects
What can be used to treat hypos?
15-20 g of a fast-acting carbohydrate, e.g.:
five glucose or dextrose tablets
five jelly babies
a small glass of a sugary (non-diet) drink
a small carton of pure fruit juice
two tubes of a glucose gel
Followed by a fast-acting carbohydrate
How long should fentanyl patches be worn for?
72 hours
What are some red flag symptoms of indigestion?
Unintentional weight loss Taking treatment for more than 4 weeks Over 55 Liver disease Previous gastric surgery Previous gastric ulcer(s)
How many hours post-UPSI can Levonelle One Step be taken?
72 hours
How many hours post-UPSI can EllaOne be taken?
120 hours (5 days)
How long does a mother have to wait before breastfeeding after taking EllaOne?
7 days
What can be used OTC to treat menorrhagia? What is the age range for supply?
Tranexamic acid; 18-45 years old
What antimalarial is contraindicated in patients with a history of depression? Why?
Mefloquine; it is associated with neuropsychiatric adverse reactions
What are some symptoms of scarlet fever?
Rough, red rash on trunk, which can spread to rest of body
Strawberry tongue
Flu-like symptoms (fever, headache, etc)
What is first-line antibiotic therapy for scarlet fever?
Phenoxymethylpenicillin QDS for 10 days
Azithromycin OD for 5 days if pen allergic
What are symptoms of slapped cheek syndrome?
Red rash on one/both cheeks, followed by rash on chest/arms/legs a few days later
Flu-like symptoms
What are some symptoms of shingles?
Itchy, painful rash on ONE side of body
Flu-like symptoms
What medicines can omeprazole interact with?
Clopidogrel - omeprazole can decrease its efficacy
Citalopram - omeprazole can increase its exposure
Methotrexate - omeprazole can decrease its clearance
What does of atorvastatin is first-line for secondary prevention of CVD?
80 mg OD (high-intensity)
Which DDP-4 inhibitor can be given to patients with renal impairment?
Linagliptin
Which DDP-4 inhibitors can be given to patients with hepatic impairment?
Linagliptin and sitagliptin
When can sodium valproate be used in pregnancy?
If it’s a last resort for treatment of epilepsy (not suitable if indicated for bipolar)
What colour can rifampicin turn urine?
Reddish-brown
What colour can nitrofurantoin turn urine?
Dark yellow/brown
What are the monitoring requirements for lithium?
BMI
Renal function
U&Es
Thyroid function
All should be done every 6 months
What should happen if a patient on azathioprine experiences unexplained bruising?
They should immediately report it to their GP, as it is a sign of bone marrow suppression
What patients are at higher risk of conceiving a child with neural defects, and will therefore need a higher dose of folic acid during their first trimester?
Patients with: Diabetes Sickle-cell anaemia Epilepsy A history of conceiving a child with neural defects
What doses of folic acid are typically given to women in their first trimester?
5 mg OD if high-risk of conceiveing a child with neural defects (POM)
otherwise, 400 mcg OD (OTC)
What are the four principle categories of child abuse?
Emotional abuse
Physical abuse
Sexual abuse
Neglect
The risk of ________ is decreased in patients taking HRT.
osteoporosis
What is the first-line treatment option for leg ulcer infections?
Flucloxacillin QDS for 7 days
Doxycycline OD or clarithromycin BD for 7 days if pen allergic
Erythromycin QDS if pregnant
What is the HAS-BLED score used for? What criteria is included?
To estimate the risk of bleeding in patients with AF being offered anticoagulation
Criteria:
HTN, renal and liver disease, Hx of stroke, Hx of/predisposition to major bleed, Hx of high INR, age (>65), medication that can cause bleeding, alcohol
What is the Wells score used for?
To determine the probability of a patient getting a DVT
Why should long-acting sulfonylureas be avoided in elderly patients?
Higher risk of prolonged hypoglycaemia
What are some symptoms of Stevens-Johnson syndrome?
Flu-like symptoms
Followed by a purple/red rash
What symptoms are associated with neuroleptic malignant syndrome?
Altered mental state
HYPERthermia (≠ fever)
Muscular rigidity
Tachycardia
What is the target INR for patients who have AF, or are being treated for DVT/PE?
2.5 (2-3)
What medication should be given to patients ASAP after a stroke?
Aspirin 300 mg STAT
What antihypertensive should be used as first-line therapy for HTN in patients with T2DM?
ACEi/ARB, irrespective of age/ethnicity
What are some symptoms of cauda equina?
Neurological deficit in lower limbs
Bladder/bowel dysfunction
Genital/perianal/perineal sensory loss
Severe lower back pain
What are some GI symptoms that might trigger a cancer pathway referral? (over 40)
Age >40 with unexplained weight loss or abdominal pain
Age >50 with unexplained rectal bleeding
Aged >60 with iron-deficiency anaemia or changes in bowel habits
What are some GI symptoms that might trigger a cancer pathway referral? (under 50)
Rectal bleeding AND one of the following: Abdominal pain Change in bowel habit Weight loss Iron-deficiency anaemia
What is a cohort study?
A study where a group of people are identified and observed over a period of time
What is a randomised controlled trial?
A study where participants are randomly chosen to receive (or not receive) a clinical intervention
What is a systematic review?
A study looking at several other studies/research about a particular topic
What is a double-blind randomised controlled trial?
A study where neither the participants nor the researchers know what the participants will receive
What is a cross-sectional study?
An epidemiological study that describes a population at a single point in time
What route should vinca alkaloids be administered?
Intravenous only
What are some clinical features of bullous impetigo?
Itchy, fluid-filled blisters lasting 2-3 days
Usually on flexures, face, trunk or limbs
Flu-like symptoms
What are some clinical features of non-bullous impetigo?
Red, itchy sores which burst quite quickly
Usually around nose/mouth
How is impetigo treated?
Localised non-bullous - hydrogen peroxide 1% cream (avoid if infection is around eyes)
Widespread non-bullous - topical OR oral antibiotic
Severe non-bullous/bullous - oral antibiotic
Which antibiotics can cause C. difficile infection?
Cephalosporins
Clindamycin
Broad-spectrum antibiotics
Quinolones
What is the weekly maximum recommended amount of alcohol?
14 units
What is the weekly minimum recommended amount of exercise?
150 mins (moderate intensity) or 75 mins (vigorous intensity)
What antiemetic should be avoided in patients with Parkinson’s?
Metoclopramide - can induce extrapyramidal side-effects
What drugs have a high risk of agranulocytosis, and therefore should not be taken concomitantly?
Methotrexate
2nd-gen antipsychotics e.g. clozapine
What is the minimum age for supply of mometasone 0.05% nasal spray?
18 years
What foods can increase the risk of gout?
Purine-rich food, e.g. red meat, seafood
What can trigger/worsen rosacea?
Stress Exercise Smoking Spicy food Hot food/drinks
Who is at high-risk of contracting typhoid?
Travellers to endemic areas where frequent/extended exposure to poor sanitation/food hygiene is likely
What are some activities that can put a patient at high-risk of contracting hepatitis B?
UPSI
Exposure to blood
Exposure to contaminated needles
Contact sports
What are some examples of mild topical corticosteroids?
Hydrocortisone (all strengths, but not hydrocortisone butyrate)
What warning labels are needed on beta-blockers?
Warning: Do not stop taking this medicine unless your doctor tells you to.
(Sudden cessation can cause rebound worsening of MI/angina)
What dose of adrenaline is given to 0-5 year olds for anaphylactic shock?
0.15 mL of 1 in 1000 solution (150 micrograms)
What dose of adrenaline is given to 6-11 year olds for anaphylactic shock?
0.3 mL of 1 in 1000 solution (300 micrograms)
What dose of adrenaline is given to 12+ year olds and adults for anaphylactic shock?
0.5 mL of 1 in 1000 solution (500 micrograms)
What needs to be monitored in children using inhaled and systemic corticosteroids? How often?
Height and weight; annually
What needs to be monitored in children using intranasal corticosteroids?
Height
Who should be considered for gradual withdrawal of systemic corticosteroids?
Patients who are unlikely to relapse and have [taken]:
> 40 mg of prednisolone OD for more than 1 week;
repeated doses in the evening;
more than 3 weeks of treatment;
recently received repeated courses;
taken a short course within 1 year of stopping long-term treatment;
other possible causes of adrenal suppression
What are three important cautions for all PPIs?
Osteoporosis - patients at risk should maintain vit D and calcium intake
Gastric cancer - look out for ‘alarm features’
Elderly - STOPP criteria: high dosage for ≥ 8 weeks if taking for ulcers or oesophagitis
What are symptoms of agranulocytosis?
Fever/chills
Bruising
Malaise
Sore throat
