Single Best Answer Set 3 Flashcards
Which of the following are false regarding irritable bowel syndrome?
A. Symptoms are usually relieved by defaecation
B. Mainly affects people aged between 45+ years of age
C. It is more common in women
D. Symptoms include abdominal pain or discomfort, disordered defaecation (either diarrhoea, or constipation with straining, and bloating)
B. Mainly affects people aged between 45+ years of age
X
20 to 30 yo
Which non-drug treatment is advised in patients with irritable bowel syndrome?
A. Eating irregularly
B. Eating at least 5 portions of fresh fruit a day
C. Drinking minimal water every day and increasing intake of caffeine, alcohol and fizzy drinks
D. Physical activity should be increased
D. Physical activity should be increased
Patients should be encouraged to increased physical activity
Which is true for the usual dose of Loperamide in adults?
A. Maximum dose is 16mg daily
B. Initially 2mg is taken
C. 4mg is then followed after each loose stool
D. Should usually be taken for up to ten days
A
Initially 4mg, followed by 2mg for up to 5 days, dose to be taken after each loose stool; usual dose 6-8mg daily; maximum 16mg per day.
Which isn’t correct regarding H. Pylori?
A. The presence of H. Pylori should be confirmed before starting eradication treatment
B. H. Pylori infection is one of the most common causes of peptic ulcer disease
C. Treatment of H. Pylori usually involves a triple-therapy regimen that comprises a proton pump inhibitor and 1 antibacterial.
D. Public Health England advise that if diarrhoea develops, whilst on drug treatment, Clostridium difficile infection should be considered and the need for treatment reviewed.
FALSE: Treatment of H. Pylori usually involves a triple-therapy regimen that comprises a proton pump inhibitor and 1 antibacterial.
Treatment of H. Pylori usually involves a triple-therapy regimen that comprises a proton pump inhibitor and 2 antibacterials.
Which of the following falls in the wrong category of laxative effect?
A. Senna – stimulant
B. Lactulose – softening
C. Methylcellulose – bulk-forming
D. Macrogol – osmotic
B. Lactulose – softening
Bulk-forming – methylcellulose, sterculia and ispaghula husk
Osmotic laxative – macrogol, lactulose
Softening laxative – docusate, arachis oil, liquid paraffin
Stimulant – Bisacodyl, co-danthromer, glycerol, senna, sodium picosulfate
Which of the following drugs below is most likely to cause Clostridium Difficile?
A. Vancomycin
B. Metronidazole
C. Loperamide
D. Omeprazole
Omeprazole
Mr Q 34-years-old has been admitted to hospital after admitting to taking an overdose of Loperamide. He is starting to exhibit signs of overdose.
What antidote can be given?
A. Digifab
B. Naloxone
C. Naltrexone
D. Ethanol
C. Naloxone
Miss P 24-years-old has recently been prescribed Co-Codamol 30mg/500mg for severe back pain, which is under investigation by the MSK team. Since starting the Co-Codamol, she has developed constipation.
Which drugs from below would be least suitable to treat Miss P’s constipation?
A. Sterculia
B. Lactulose
C. Macrogol 3350
D. Senna
A. Sterculia
Opioid induced constipation.
Solution; osmotic + stimulant
Sterculia - bulk
Lactulose - osmotic
Macrogol 3350 - osmotic
Senna- stimulant
Mr C, 47 years old has been diagnosed with COPD for a while. He does not smoke, after successfully adhering with the smoking cessation clinic run by the practice nurse. The GP has been reviewing his notes after another discharge letter arrived relating to a COPD exacerbation, his 5th this year. Mr C is on optimised inhaled therapies and is currently taking the following medicines for managing his COPD:
Trimbow pMDI®: 2 Puffs BD
Salbutamol 100mcg: 1-2 puffs QDS PRN
Carbocisteine 375mg: 2 TDS
The GP is looking to initiate a prophylactic antibiotic due to the frequent and prolonged exacerbations with sputum production.
Which of the following antibiotics would be most likely to be considered?
A. Amoxicillin 500mg – 1 TDS
B. Azithromycin 250mg – One 3 times per week
C. Azithromycin 250mg – 1 OD
D. Clarithromycin 250mg – One 3 times per week
Azithromycin 250mg – 1 OD
Bnf;
After considering if respiratory specialist input is required, considerazithromycin[unlicensed] prophylaxis to reduce the risk of exacerbations in patients who are non-smokers, have had all other treatment options optimised, and who continue to either have prolonged or frequent (4 or more per year) exacerbations with sputum production, or exacerbations resulting in hospitalisation. Ensure sputum culture and sensitivity testing, a CT scan of the thorax (to rule out other lung pathologies), a baseline ECG (to rule out QT prolongation), and LFTs are performed before offering prophylaxis. Review treatment after the first 3 months, then at least 6 monthly thereafter; only continue if benefits outweigh risks.
When using Peak Expiratory Flow (PEF) as one of the measures to categorise the severity of an acute asthma. What PEF (best/predicted) would you expect to find for an adult who is defined as having a severe asthma attack?
A. <33%
B. 50-75%
C. 33-50%
D. >75%
C.
PEF;
Moderate; 50 - 75%
Severe; 33-55%
Life threatening; <33%
Moderate; normal speech, no features of severe/Life threatening asthma
Severe; resp rate at least 25bpm, >1 breath to complete sentences, pulse rate at least 110 bpm
Life threatening; o2 sat <92%, exhaustion, hypotension, silent chest, cardiac arrhythmia, cyanosis, poor resp effort
Mr P 31 years old, has been visiting the smoking cessation clinic at the practice. After a period of several months, he has successfully managed to quit smoking. The nurse refers him to the GP as she believes that a dosage adjustment may be necessary as a result of Mr P stopping smoking.
Which drug from below may require a dosage adjustment as a result of stopping smoking?
A. Theophylline
B. Montelukast
C. Salbutamol
D. Sodium Cromoglicate
smokingcause increase oftheophyllineclearance by 58–100% and decrease its half life (T/2) by 63% in thesmokersorganism compared with nonsmokers. This is because it is highly metabolized by CYP1A2.theophylline dose usually doubled if smoker.
Mr CP, who is 67 years old, is currently suffering from persistent breathlessness due to his COPD. He has already been previously prescribed and uses a salbutamol inhaler which is no longer controlling his symptoms. His FEV1 is 55%.
Which ONE of the following is the most appropriate treatment option?
A. Short-acting muscarinic antagonist
B. Domiciliary oxygen
C. Long acting beta2 agonist plus inhaled corticosteroid
D. Long acting muscarinic agonist
E. Long acting muscarinic antagonist plus long acting beta2 agonist plus inhaled corticosteroid
D
If FEV1 is greater than 50%, the next step would be to add a LAMA or a LABA alone.
¿¿ don’t know where guideline for this is ??
My research;
Mild airflow obstruction 50–80% predicted
Moderate airflow obstruction 30–50% predicted
Severe airflow obstruction < 30% predicted
Copd
1st line; SABA or SAMA
Step up no asthmatic symptoms SABA continue and;
- LABA + LAMA (discontinue SAMA if switch to LAMA)
- if day to day symptoms still affect QoL trial 3 month ICS
Severe exacerbation (hospitalisation) or at least 2 mod exacerbations (requiring systemic corticosteroids and/or antibacterial treatment) within a year;
- add ICS [triple therapy] review annually
Step up asthmatic symptoms;
- LABA + ICS
severe exacerbation (requiring hospitalisation) or at least two moderate exacerbations (requiring systemic corticosteroids and/or antibacterial treatment) within a year, or who continue to have day-to-day symptoms adversely impacting their quality of life, add
- LAMA [triple therapy] discontinue SAMA
Mrs M, who is 64 years old, has been admitted to hospital due to an infective exacerbation of COPD. She has been prescribed nebulised medication to relieve her symptoms. Nurse R commented on that certain nebulised medication can cause acute angle-closure glaucoma if the patients eyes are not protected.
Which ONE of the following medication is the nurse referring to?
A. Budesonide B. Ipratropium C. Salbutamol D. Fluticasone E. Terbutaline
Ipratropium
BNF Caution: Acute angle-closure glaucoma has been reported with nebulised ipratropium, particularly when given with nebulised salbutamol (and possibly other beta2 agonists); care needed to protect the patient’s eyes from nebulised drug or from drug powder.
Mr T is a 54-yo who has been admitted to hospital after persistent SOB and has been diagnosed with having an acute severe exacerbation of his COPD. He has been given a slow IV injection of aminophylline followed by a maintenance dose via IV infusion.
Which ONE of the following is the most appropriate plasma-drug concentration required for satisfactory bronchodilation?
A. 10-20 mcg/L B. 10-20 mg/L C. 55-110 mcg/L D. 20-30 mg/L E. 15-20 mg/L
B.
In most individuals, a plasma-theophylline concentration of 10-20mcg/ml or 10–20 mg/litre (55–110 micromol/litre) is required, although 5-15mcg/ml may be effective. ADR occur within 10-20mg/litre and both the freq and severity increase > 20mg/litre.
Aminophylline is a compound of the bronchodilator theophylline with ethylenediamine in 2:1 ratio. The ethylenediamine improves solubility, and the aminophylline is usually found as a dihydrate. Aminophylline is less potent and shorter-acting than theophylline.
An 11-year-old boy is admitted to hospital with an infective exacerbating of asthma. He has a past medical history of asthma, which has been well controlled until the development of infection. He is penicillin allergic. His current medication is as follow:
Salbutamol 100mcg MDI 2 puffs PRN
Seretide accuhaler 100 1 puff BD
Which of the following would be the most appropriate first line treatment?
A. Nebulised salbutamol with a course of prednisolone tablets
B. Nebulised salbutamol with dexamethasone oral solution
C. Nebulised salbutamol with hydrocortisone tablets
D. Nebulised salbutamol with SMART therapy
E. Nebulised terbutaline and nebuliser ipratropium
A. Nebulised salbutamol with a course of prednisolone tablets
SMART = Single Maintenance And Reliever Therapy
For acute asthma in children over 5 yo inhaled SABS are first line treatment. Oral steroids early in the treatment of acute asthma is extremely beneficial and can prevent hospital admission in emergency departments. Oral prednisolone is the steroid of choice.
Which of the following is classed as a “Loop Diuretic”?
A. Bumetanide
B. Amiloride
C. Metolazone
D. Bendroflumethiazide
Bumetanide = loop diuretic
Amiloride = k sparing diuretic
Metolazone = thiazide-like diuretic
Bendroflumethiazide = thiazide diuretic
Some beta-blockers are classed as “Cardio-selective”. These beta-blockers predominantly work on the B1 receptors in the heart.
Which of the following beta-blockers is not classed as “cardio-selective”?
A. Atenolol
B. Metoprolol
C. Nebivolol
D. Propranolol
Propranolol
Be A MAN
Atenolol,bisoprolol,metoprolol,nebivolol, and (to a lesser extent)acebutolol, have less effect on B2 (bronchial) receptors and are, therefore, relativelycardioselective, but they are notcardiospecific. They have a lesser effect on airways resistance but are not free of this side-effect.
Intrinsic sympathomimetic activity (ISA, partial agonist activity) represents the capacity of BB to stimulate AND block adrenergic receptors. Celiprolol, acebutolol,pindolol and oxprenolol have intrinsic sympathomimetic activity; they tend to cause less bradycardia and less coldness of the extremities.
You are discussing with the nursing team the number of patients who are coming into the surgery to get their INR tested due to being on warfarin. As part of a measure to try and reduce this you identify a cohort of patients who are eligible and willing to switch over to a DOAC.
One of the nurses asks what a patients INR should ideally be if they are to switch over to Apixaban from Warfarin straight away?
A. <2
B. <2.5
C. Between 2-3
D. >2.5
<2 INR
Mr Q has been admitted to hospital due to having blackouts and heart palpitations. An ECG was conducted, and Mr Q was found to have a prolonged QT interval. Upon reviewing his medication, you see that he is taking Sotalol.
Which of the following drugs below can cause an increased risk of QT prolongation when taken alongside Sotalol?
A. Digoxin
B. Naproxen
C. Citalopram
D. Methotrexate
Citalopram - SSRI
QT prolongation drugs ◇ Quinolones; moxifloxacin ◇ Antibiotics; Clarithromycin, Erythromycin ◇ Azoles; ketoconazole, fluconazole ◇ SSRIs ◇ Omeprazole ◇ Lithium ◇ sumatriptan ◇ methadone ◇ Antiarrhythmics; amiodarone, sotalol, procainamide ◇ TCAs ◇ Anti psychotics; risperidone, quetiapine, clozapine, chlorpromazine, haloperidol, fluphenazine
Which of the drugs below, used for the treatment of stable angina can cause serious skin, mucosal and eye ulceration, including gastrointestinal ulcers?
A. Atenolol
B. Bisoprolol
C. Nicorandil
D. Verapamil
Nicorandil
Prophylaxis and treatment of stable angina (2nd-line)
Initially 5–10 mg bd, then increased if tolerated to 40 mg bd; usual dose 10–20 mg bd, use lower initial dose regimen if patient susceptible to headache.
Nicorandil can cause serious skin, mucosal, and eye ulceration; including gastrointestinal ulcers, which may progress to perforation, haemorrhage, fistula or abscess. Stop treatment if ulceration occurs and consider an alternative.
Mrs P, presents to you a prescription for Perindopril 4mg tablets. She informs you; she has just been diagnosed with having hypertension and has been put onto these tablets.
What is the most accurate counselling advice to give to Mrs P, regarding Perindopril tablets?
A. The first dose should preferably be given in the morning
B. Take with or just after food, or a meal
C. Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food
D. Take 30 to 60 minutes before food
Take 30 to 60 min before food
Aspirin should not be given to children under the age of 16 due to the risk of developing Reye’s syndrome.
Which ONE of the following signs and symptoms is least likely to occur?
A. Vomiting B. Seizures C. Muscle aches D. Raised white cell count E. Delirium
C. Muscle aches
Initial symptoms of Reye’s syndrome can include persistent, effortless vomiting, lack of interest/enthusiasm and a loss of energy, drowsiness, rapid breathing and seizures. As the condition progresses, the symptoms may become more severe and wide ranging and can include personality changes such as extreme irritability, aggressive behaviour, delirium and coma. LFTs and WCC are normally raised.
Mrs R who develops tachycardia whilst recovering from her operation. Her pulse is 100 beats per minute. Doctors wish to control the rate whilst they investigate the cause of the atrial fibrillation.
Which ONE of the agents listed should be used as first line treatment to obtain rate control?
A. Amiodarone B. Amlodipine C. Digoxin D. Bisoprolol E. Verapamil
Bisoprolol
Mr AB is 43 yo and has come to his GP. He is of African descent, takes metformin 1g bd and recently BP is persistently above 140 systolic and 90 diastolic mmHg.
What’s recommended treatment of choice for antihypertensive?
A. Amlodipine 5 mg od
B. Amlodipine 5 mg od and candesartan 8mg od
C. Candesartan 8mg OD
D. Amlodipine 5mg od and Ramipril 2.5mg od
E. Ramipril 2.5 mg od
C. Candesartan 8mg od - ARB
■Step 1
Offer ACEi or ARB who have
a. have type 2 DB and are of any age or family originor
b. are aged under 55 but not of black African or African–Caribbean family origin
Offer CCB if they
a. are aged 55 or over and do not have type 2 DBor
b. are of black African or African–Caribbean family origin and do not have type2 diabetes (of any age)
Offer Thiazide like diuretic if evidence of HF
■Step 2
Step 1 ACEi/ARB fail; Add CCB or Thiazide like diuretic
Step 1 CCB fail; ACEi or ARB or Thiazide like diuretic
Black origin non DB; prefer ARB to ACEi
IfHTN uncontrolled in black African family origin who do not have type2 DB taking step1 treatment, consider an ARB, in preference to an ACE inhibitor, in addition to step1 treatment.
■ Step 3 ~ Offer a combination of:
an ACE inhibitor or ARBand
a CCBand
a thiazide-like diuretic
