Respiratory

Question 1

Most common organisms isolated from patients with bronchiectasis

Answer 1

Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae

Question 2

Drugs that cause SI ADH

Answer 2

Sulphylureas

Question 3

Oculogyrric crisis treatment

Answer 3

intravenous antimuscarinic: benztropine or procyclidine

Question 4

Adverse effects of cyclosporin

Answer 4

Adverse effects of ciclosporin (note how everything is increased - fluid, BP, K+, hair, gums, glucose)
nephrotoxicity
hepatotoxicity
fluid retention
hypertension
hyperkalaemia
hypertrichosis
gingival hyperplasia
tremor
impaired glucose tolerance
hyperlipidaemia
increased susceptibility to severe infection

Question 5

Quinine toxicity

Answer 5

Quinine toxicity (cinchonism) presents with myriad ECG changes, hypotension, metabolic acidosis, hypoglycaemia and classically tinnitus, flushing and visual disturbances. Flash pulmonary oedema may occu

Question 6

Unfractionated heparin MoA

Answer 6

Activates antithrombin III

Question 7

Patients with MI secondary to cocaine use should be given

Answer 7

Patients with MI secondary to cocaine use should be given IV benzodiazepines as part of acute (ACS) treatment

Question 8

Salicylate overdose management

Answer 8

Treatment
general (ABC, charcoal)
urinary alkalinization with intravenous sodium bicarbonate - enhances elimination of aspirin in the urine
haemodialysis

Question 9

Adrenaline induced ischaemia treatment

Answer 9

phentolamine

Question 10

Herceptin monitoring/adverse effect

Answer 10

Trastuzumab (Herceptin) - cardiac toxicity is common

monitoring with an echo

Question 11

SE of ciclosporin

Answer 11

Ciclosporin side-effects: everything is increased - fluid, BP, K+, hair, gums, glucose

Question 12

Therapeutic drug monitoring of lithium

Answer 12

ithium
range = 0.4 - 1.0 mmol/l
take 12 hrs post-dose

Question 13

Therapeutic drug monitoring of digoixin

Answer 13

Digoxin
at least 6 hrs post-dose

Question 14

Therapeutic drug monitoring of phenytoin

Answer 14

Phenytoin levels do not need to be monitored routinely but trough levels, immediately before dose should be checked if:
adjustment of phenytoin dose
suspected toxicity
detection of non-adherence to the prescribed medication

Question 15

Therapeutic drug monitoring of ciclosporin

Answer 15

Ciclosporin
trough levels immediately before dose

Question 16

Loss of vision associated with which kind of poisoining

Answer 16

Loss of vision is seen in methanol rather than ethylene glycol poisoning

Question 17

mechanism of action of allopurinol?

Answer 17

Allopurinol inhibits xanthine oxidase

Question 18

Metformin MoA

Answer 18

Metformin acts by activation of the AMP-activated protein kinase (AMPK)

Question 19

TCA overdose management

Answer 19

Management
IV bicarbonate
first-line therapy for hypotension or arrhythmias
indications include widening of the QRS interval >100 msec or a ventricular arrhythmia
other drugs for arrhythmias
+ class 1a (e.g. quinidine) and class Ic antiarrhythmics (e.g. Flecainide) are contraindicated as they prolong depolarisation
class III drugs such as amiodarone should also be avoided as they prolong the QT interval
response to lignocaine is variable and it should be emphasized that correction of acidosis is the first line in the management of tricyclic-induced arrhythmias
intravenous lipid emulsion is increasingly used to bind free drug and reduce toxicity
dialysis is ineffective in removing tricyclics

Question 20

Mercury poisoning characteristics

Answer 20

Mercury poisoning can cause visual field defects, hearing loss and paraesthesia

eatures
paraesthesia
visual field defects
hearing loss
irritability
renal tubular acidosis

associated with eating fish and whale

Question 21

Lead poisioning features

Answer 21

Lead poisoning may also result from industrial exposure. However, patients typically present with abdominal pain, constipation and neuropsychiatric symptoms as well as blue gum margin lines. Lead poisoning is not associated with visual or hearing issues a

Question 22

Aspirin MoA

Answer 22

Aspirin decreases the formation of thromboxane A2 resulting in decreased platelet aggregation

(COX1 and COX2 irrevesible inhibitiion)

Question 23

Alpha 2 action

Answer 23

Alpha-2
mainly presynaptic: inhibition of transmitter release (inc NA, Ach from autonomic nerves)
inhibits insulin
platelet aggregation

This is why alpha 2 agonists like methyldopa and clonidine are used to treat hypertension & agitation

Question 24

Beta-3 action

Answer 24

Beta-3 receptors are mainly found in adipose tissue where they stimulate lipolysis upon activation by sympathetic stimuli. T

Question 25

Ketamine

Answer 25

Ketamine is an NMDA receptor antagonist

Question 26

Alpha 1 MoA

Answer 26

Alpha-1 receptors, on the other hand, are primarily post-synaptic and mediate excitatory responses. They are typically found on vascular smooth muscle cells and cause vasoconstriction when stimulated. e.g. metraminol, phenylephrine

Question 27

Abcixumab MoA

Answer 27

Abciximab is a glycoprotein IIb/IIIa receptor antagonist

Question 28

DOAC MoA

Answer 28

Directly inhibits factor Xa

Question 29

Acute intermittent porphyria drugs that are safe to use

Answer 29

Drugs which may precipitate attack (Blood Problems Have A Sneaky Behaviour) * Barbiturates * Pill- OCP * Halothane * Alcohol * Sulphonamides * Benzodiazepines

Question 30

what diabetic drug can cause B12 deficiency

Answer 30

. Metformin, an oral antidiabetic drug, can cause vitamin B12 deficiency by altering small bowel motility, leading to bacterial overgrowth and deconjugation of bile salts, which in turn impairs B12 absorption. The British Society for Haematology guidelines recommends checking B12 levels in patients on metformin if there is suspicion of deficiency.

Question 31

Side effects of nicorandil:

Answer 31

headache, flushing and anal ulceration

Question 32

SE of b blockers

Answer 32

* Bronchospasm (especially in asthmatics) * Fatigue * Cold peripheries * Sleep disturbances

Question 33

Lithium toxicity can be precipitated by ACE inhibitors

Answer 33

Lithium toxicity can be precipitated by ACE inhibitors

Question 34

ABx that causes pulmonary fibrosis

Answer 34

Nitrofurantoin

Question 35

Abx class that Inhibits DNA synthesis

Answer 35

quinolones e.g. cipro

Question 36

Heparin-induced thrombocytopaenia - antibodies f

Answer 36

Antibodies against complexes of platelet factor 4 (PF4) and heparin. This patient has thrombocytopenia, which can be caused by heparin-induced thrombocytopenia (HIT). HIT is an immune-mediated adverse effect of heparin therapy, where antibodies form against complexes of platelet factor 4 (PF4) and heparin. This leads to platelet activation and increased risk of thromboembolic events, despite the low platelet count.

Question 37

sarcoidosis CXR findings

Answer 37

Sarcoidosis CXR 1 = BHL 2 = BHL + infiltrates 3 = infiltrates 4 = fibrosis

Question 38

indications to treat sarcoidosis

Answer 38

If the Sarcoid cannot PUNCH, leave him alone P-Parenchymal lung disease U-Uveitis N-Neuro involvement C- Cardio involvement H- Hypercalcemia

Question 39

Contraindications to lung cancer surgery

Answer 39

Contraindications to lung cancer surgery include SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis

Question 40

Alpha-1 antitrypsin deficiency geneotype associated with symptoms

Answer 40

PiZZ Genetics located on chromosome 14 inherited in an autosomal recessive / co-dominant fashion* alleles classified by their electrophoretic mobility - M for normal, S for slow, and Z for very slow normal: PiMM heterozygous: PiMZ evidence base is conflicting re: risk of emphsema however, if non-smoker low risk of developing emphsema but may pass on A1AT gene to children homozygous PiSS: 50% normal A1AT levels homozygous PiZZ: 10% normal A1AT levels

Question 41

Light's Criteria for exudative effusion r

Answer 41

Light's Criteria for exudative effusion requires one of more of the following: Pleural fluid protein / Serum protein >0.5 Pleural fluid LDH / Serum LDH >0.6 Pleural fluid LDH > 2/3 * Serum LDH upper limit of normal Glucose is not used in Light's Criteria.

Question 42

Extrinsic allergic alveolitis (same as hypersensitivity pneumonitis) is a type III and IV reaction,

Question 43

indications for placing a chest tube in pleural infection:

Answer 43

Patients with frankly purulent or turbid/cloudy pleural fluid on sampling should receive prompt pleural space chest tube drainage. The presence of organisms identified by Gram stain and/or culture from a non-purulent pleural fluid sample indicates that pleural infection is established and should lead to prompt chest tube drainage. Pleural fluid pH < 7.2 in patients with suspected pleural infection indicates a need for chest tube drainage.

Question 44

chemicals is associated with occupational asthma: most common

Answer 44

isocyanates

Question 45

LoFGrEN'S

Answer 45

LoFGrEN'S - Lymphadenopathy, Fever, Girls, Erythema Nodosum, Sarcoidosis....

Question 46

lung condition that prdisposes to TB

Answer 46

scilicosis predisposes to tuberculosis

Question 47

COPD - LTOT indications

Answer 47

COPD - LTOT if 2 measurements of pO2 < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following: secondary polycythaemia peripheral oedema pulmonary hypertension

Question 48

t HRCT shows an eggshell calcification pattern.

Answer 48

scilicosis

Question 49

responsible for malt workers' lung?

Answer 49

asprgillus clavetus