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Medical Finals > The calm before the storm (things I still can't remember) > Flashcards

The calm before the storm (things I still can't remember) Flashcards

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USMLE® Step 1 flashcards
1
Q

Dopamine agonists

A

Ropinirole
Pramipexole
Rotigotine

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2
Q

Ergot derived drugs

A

Pergolide
Cabergoline
Bromocriptine

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3
Q

SEs of ergot derived drugs

A

Cardiac valve fibrosis and other fibrotic syndromes

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4
Q

What smoothes levodopa response in parkinsons

A

COMTi, MAOI

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5
Q

What can improve neuropsych symptoms in parkinsons

A

Atypical neuroleptics, donepezil

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6
Q

What can you use in crises in parkinsons

A

Apomorphine (sc)

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7
Q

What is benzhexol’s role in parkinsons

A

younger patients with tremor (v limited)

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8
Q

What do you use for acute dystonia inc oculogyric crisis?

A

anticholinergics

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9
Q

What do you use for parkinsonian syndrome (neuroleptic side effect)?

A

Anticholinergics, dopamine agonists

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10
Q

What can you use for akathisia?

A

Beta blockers

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11
Q

What can you use for tardive dyskinesia?

A

Switch to atypical neuroleptic

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12
Q

What can you use for neuroleptic malignant syndrome?

A

Dantrolene, dopamine agonists (may last for 7+ days after drug stopped)

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13
Q

What is the side effect of vigabatrin?

A

Visual field defects

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14
Q

Which anti epileptics are strong enzyme inducers?

A

Carbamazepine, phenytoin

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15
Q

Which anti epileptics are weak enzyme inducers?

A

Oxcarbazepine, valproate, topiramate

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16
Q

Which anti epileptics are susceptible to action of other enzyme inducers/inhibitors?

A

Lamotrigine, tiagabine, zonisamide

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17
Q

For fatigue in MS give

A

Amantadine, modafinil

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18
Q

For pain in MS give

A

Amitriptyline, pregabalin, gabapentin

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19
Q

For spasticity in MS give

A

Baclofen, danrolene, diazepam, tizanidine, botox, physio

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20
Q

For bladder disturbance in MS give

A

Oxybutynin, tolterodine, catheter

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21
Q

For tremor in MS give

A

Clonazepam, primidone

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22
Q

Antimuscarinic antiemetic and when do you give it

A

Hyoscine, for motion sickness

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23
Q

Antihistamine antiemetic and when do you give it

A

Cinnarizine, cyclizine - motion sickness and vestibular disorders

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24
Q

DA antagonist antiemetic and when do you give it

A

Metoclopramide, domperidone - post op nausea

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25
Q

5-HT3 antagonist antiemetic and when do you give it

A

Ondansetron - chemo and post op

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26
Q

Steroid antiemetic and when do you give it

A

Dexamethasone - chemo

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27
Q

Cannabinoid antiemetic is

A

Nabolone

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28
Q

Problems with lithium?

A

Nephrogenic DI, tremor, ataxia, hypothyroid, renal tubular acidosis (type 1), interacts with diuretics, needs monitoring

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29
Q

What are some typical antipsychotics

A

Haloepridol, perchlorphenazine

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30
Q

What are some atypical antipsychotics

A

Clozapine, olanzapine, risperidone, aripiprazole

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31
Q

What’s the difference between 1st and 2nd gen antipsychotics

A

More extrapyramidal side effects with 1st gen. Weight gain, metabolic syndrome and diabetes with 2nd gen

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32
Q

SE of olanzapine

A

Cardiomyopathy

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33
Q

Medications associated with GORD

A

CCBs, nitrates, theophylline, bisphosphonates, steroids (including inhaled), NSAIDs, aspirin, clopidogrel

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34
Q

What’s the problem with using H2 receptor antagonists in GORD and what are the names of some

A

Ranitidine, famotidine, cimetidine; tachyphylaxis (reduction of efficacy in 2-6 weeks)

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35
Q

Which H2 receptor antagonist is a strong inhibitor of CYP450

A

Cimetidine

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36
Q

Standard H pylori eradication regimen

A

PPI twice daily (normally omeprazole 20mg)
Amox 1g BD
Clari 500mg BD (if recent use of macrolide use metronidazole 400mg TDS)

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37
Q

Standard H pylori eradication regimen if penicillin allergic

A

PPI + clari 500mg BD + metro 400mg BD

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38
Q

NSAID with lowest risk of GI toxicity

A

Ibuprofen

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39
Q

5-ASA rare but serious side effect

A

Blood dyscrasias

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40
Q

Do you need to monitor azathioprine?

A

Yes

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41
Q

Most significant adverse effect of anti TNFalpha drugs?

A

Immunosuppression

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42
Q

What is infliximab rarely associated with which is very serious?

A

Life threatening hypersensitivity - have resus equipment when administering it

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43
Q

What can you give for abode pain in IBS?

A

Low dose TCA, SSRIs (unlicensed), peppermint oil capsules

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44
Q

How do you treat osteoarthritis?

A

Paracetamol + topical NSAID
If ineffective consider NSAID (unless on low dose aspirin in which case consider mild opioid)
Intra articular corticosteroids

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45
Q

How do you choose an NSAID?

A

Ibuprofen first line because it has lowest incidence of GI toxicity. If history of cardio disease give naproxen first line instead.

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46
Q

Which DMARDs are associated with blood dyscrasias?

A

Methotrexate, sulfasalazine

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47
Q

What SE is specific to hyroxychloroquine

A

Ocular toxicity

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48
Q

SEs of allopurinol

A

Itch, rash

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49
Q

SEs of colchicine

A

Abdo cramps, diarrhoea

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50
Q

Examples of alkylating agents

A

cyclophosphamide, chlorambucil, busulfan

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51
Q

Examples of antimetabolite chemo drugs

A

5-flurouracil, methotrexate, gludarabine

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52
Q

Examples of cytotoxic antibiotics

A

Doxorubicin, bleomycin

53
Q

Examples of vinca alkaloids

A

Vincristine, vinblastine

54
Q

Examples of taxanes

A

Paclitaxel

55
Q

Examples of TK inhibitors

A

Imatinib, nilotinib

56
Q

Examples of immunomodular chemo

A

Thalidomide

57
Q

Examples of endocrine modulators used as chemo

A

Tamoxifen, anastrozole, cyproterone

58
Q

SEs of cyclophosphamide

A

Haemorrhagic cystitis, BM suppression, alopecia (MESNA reduces incidence of cystitis)

59
Q

SEs of doxorubicin

A

Cardiomyopathy, BM suppression

60
Q

SEs of bleomycin

A

pulmonary fibrosis

61
Q

SEs of vincristine

A

Peripheral neuropathy

62
Q

SEs of paclitaxel

A

Hypersensitivity, peripheral neuropathy

63
Q

SEs of 5-FU

A

Mucositis

64
Q

SE of ondansetron

A

Constipation, headache, dizziness

65
Q

What kind of antiemetic do you usually use for platinum chemo regimens?

A

Neurokinin 1 antagonists e.g. aprepitant

66
Q

What are the common SEs of aprepitant

A

Hiccups, constipation and diarrhoea

67
Q

What are the adverse effects of nabilone?

A

Drowsiness, euphoria, visual disturbances

68
Q

What do you use amifostine for?

A

Reduce neutropenia and nephrotoxicity associated with cisplatin; protection xerostomia during head/neck radiotherapy

69
Q

What do you use G-CSF for in chemo?

A

Reducing neutropenia (not used routinely)

70
Q

SE of G-CSF?

A

Prolonged use -> myeloid malignancy

71
Q

What do you use rasburicase for in chemo?

A

Prevention and treatment of tumour lysis syndrome

72
Q

What is rasburicas?

A

Recombinant enzyme which metabolises uric acid to allantoin

73
Q

What are the SEs of rasburicase?

A

Fever and hypersensitivity reactions

74
Q

How do you treat neutropenic sepsis?

A

Culture (2 sets) and tazocin

75
Q

SEs of codeine?

A

Constipation, drowsiness and rash

76
Q

What is a small but serious risk of tramadol?

A

Serotonin syndrome when combined with other CNS drugs

77
Q

What is the normal starting dose of morphine?

A

20-30mg daily

78
Q

Common SEs of morphine?

A

Constipation, nausea, vomiting, dry mouth

79
Q

How do you prescribe breakthrough morphine?

A

1/6 total daily morphine requirement, if needing >2 doses in 24h then increase background amount

80
Q

What’s the difference between oxycontin and oxynorm?

A

Oxycontin is sustained release, oxynorm is immediate release

81
Q

Difference between oxycodone and morphine?

A

Oxycodone less constipating but can be more sedating

82
Q

What do you have to be careful of with fentanyl?

A

x200 more potent. Significant risk of accidental overdose. Exposure to external heat significantly increases release from patch

83
Q

Advantages of diamorphine?

A

Less nausea and hypotension

84
Q

How do you convert PO morphine to IM or SC dose?

A

Half the dose

85
Q

How do you convert oral morphine to syringe driver?

A

Divide by 3 for dose

86
Q

What’s the first line for trigeminal neuralgia?

A

Carbamazepine

87
Q

SEs of carbamazepine?

A

Sedation and anti muscarinic side effects

88
Q

What are the anti muscarinic side effects?

A

Dry mouth, blurred vision, constipation, urinary retention

89
Q

SEs of gabapentin, pregabalin?

A

Dizziness, fatigue, drowsiness, weight gain

90
Q

Management of hypertensive emergency?

A

Nitroprusside (+ beta blocker), monitor intra arterial BP, reduce mean BP by 15-25% in first hour, not more

91
Q

Antidote to aluminium

A

Desferrioxamine

92
Q

Antidote to arsenic

A

Dimercaprol, succimer

93
Q

Antidote to beta adrenoceptor blockers

A

atropine, glucagon

94
Q

Antidote to CCBs

A

atropine

95
Q

Antidote to carbamate insecticides

A

atropine

96
Q

Antidote to copper

A

D-penicillamine, unithiol

97
Q

Antidote to cyanide

A

dicobalt edentate, hydroxocobalamin, oxygen, sodium nitrite, sodium thiosulphate

98
Q

Antidote to diethylene glycol

A

ethanol, fomepizole

99
Q

Antidote to digoxin

A

atropine, digoxin antibodies

100
Q

Antidote to hydrogen sulphide

A

oxygen

101
Q

Antidote to lead

A

sodium calcium edentate, DMSA

102
Q

Antidote to methaemoglobinaemia

A

methylthioninium chloride (methylene blue)

103
Q

Antidote to mercury

A

unithiol

104
Q

Antidote to nerve agents

A

atropine, HI-6, obidoxime, pralidoxime

105
Q

Antidote to oleander

A

digoxin antibodies

106
Q

Antidote to organophosphorus insecticides

A

atropine, obidoxime, pralidoxime

107
Q

Antidote to thallium

A

prussian blue

108
Q

Treatment of SVT

A

Vagal manoeuvre, if not adenosine, if not verapamil, if not cardiovert

109
Q

Treatment of status

A

Lorazepam or diazepam 1st line, diazepam rectally or midazolam via buccal mucosa, phenytoin if not successful

110
Q

Treatment of acute severe asthma

A 
Oxygen
Bronchodilators: salbutamol and ipratropium neb
Steroids
Consider continuous salbutamol
Add magnesium
Consider IV salbutamol or aminophylline
ITU
111
Q

What combination of rate control drugs can you not give in AF

A

Diltiazem and beta blocker

112
Q

What do you give for AF rate control?

A

Beta blocker or diltiazem or verapamil +/- dixogin

113
Q

Treatment of CCF?

A

ACEI or ARB core treatment
Diuretic (loop) generally needed
Add low dose beta blocker: carvedilol, bisoprolol, nebivolol not atenolol
Add spiro (eplerenone)
Add digoxin usually in AF, otherwise for symptom control only
Nitrates can improve some symptoms
Can be added to hydralazine

114
Q

Management of stable angina?

A

Aspirin/clopidogrel and statin
GTN might be enough
Beta blockers most effective prevention, diltiazem/verapamil if contraindicated
All contraindicated in LV dysfunction
Add long acting nitrate (ISMN) to beta blocker or CCB
Can add dihydropyridine to beta blocker
Consider nicorandil, ivabradine (causes severe brady), ranolazine
If persists think again about revascularisation

115
Q

What can you add for hypertension after A + C+ D?

A

further diuretic, alpha blocker, beta blocker

116
Q

Which antihypertensives can you use in pregnancy?

A

Methyldopa, hydrazine, nifedipine, labetalol

117
Q

SEs of statins

A

Rhabdo, renal toxicity, GI disturbance, sleep disturbance, erectile dysfunction

118
Q

Thyroglossal cyst

A

Located in the anterior triangle, usually in the midline and below the hyoid (65% cases)
Derived from remnants of the thyroglossal duct
Thin walled and anechoic on USS (echogenicity suggests infection of cyst)

119
Q

Branchial cyst

A

Six branchial arches separated by branchial clefts
Incomplete obliteration of the branchial apparatus may result in cysts, sinuses or fistulae
75% of branchial cysts originate from the second branchial cleft
Usually located anterior to the sternocleidomastoid near the angle of the mandible
Unless infected the fluid of the cyst has a similar consistency to water and is anechoic on USS

120
Q

dermoid cyst

A

Derived from pleuripotent stem cells and are located in the midline
Most commonly in a suprahyoid location
They have heterogeneous appearances on imaging and contain variable amounts of calcium and fat

121
Q

Cystic hygroma

A

Soft and transilluminates; most in posterior triangle

122
Q

HbA1c target

A

6.0 if lifestyle only, 6.5 if lifestyle and metformin, 7.0 if any drug that might cause hypos

123
Q

Vessel affected if Complete heart block following a MI?

A

Right coronary

124
Q

Hypertension in diabetes, first line is

A

Ramipril regardless of age

125
Q

pharm cardioversion in AF with structural heart disease

A

amiodarone (not flecainide)

126
Q

What kind of BBB in ASDs?

A

Right

127
Q

How does colorectal screening work

A

Faecal occult blood (FOB) test kits are sent every 2 years to all patients aged 60-74 years in England, 50-74 years in Scotland

128
Q

Sensory loss in syringomyelia

A

spinothalamic sensory loss (pain and temperature)

Medical Finals (11 decks)

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