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Year 4 > Transition Block > Flashcards

Transition Block Flashcards

1
Q

Monitoring Requirements for Methotrexate

A

Every 1-2 weeks whilst dose is being adjusted, every 2-3 months once on stable dose

FBC - can cause bone marrow suppression
Any drop in WBC or platelets should withdraw drug

LFTs - if abnormal, withdraw the drug until abnormalities return to normal and recommence drug

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2
Q

My Structure for Review History Taking

A

Clarify - condition, how long for, symptoms presenting with/currently have
Last Seen - how have you been since then, who saw you
Management - current regimen, medications/any supplements/any OTC, any monitoring requirements, sick day rules
Systemic Enquiry - check for red flags
Social History - alcohol, smoking, occupation, impact of condition/ICE

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3
Q

Framework for Alcohol Brief Intervention

A

Raising the issue of alcohol
Screening and giving feedback
Listening for readiness to change
Selecting an approach

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4
Q

Alcohol Recommendations

A

Not to drink >14 units per week and best to spread evenly over 3 days or more (ensuring have some alcohol free days

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5
Q

Side effect of PPIs

A

Hyponatraemia

Consider switching to ranitidine

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6
Q

Blood Draw Order

A 
Light Blue 
Red 
Dark Blue 
Yellow 
Dark Green 
Green 
Purple 
Pink 
Grey
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7
Q

Light Blue Blood Draw

A 
INR
aPTT
PT
Fibrinogen
D-dimer
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8
Q

Red Blood Draw

A

Platelet AB screen

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9
Q

Dark Blue Blood Draw

A

Trace elements

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10
Q

Yellow Blood Draw

A

Biomedical tests
B12
Folate
Serology

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11
Q

Dark Green Blood Draw

A

EPO

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12
Q

Green Blood Draw

A

Fast track biomedical tests

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13
Q

Purple Blood Draw

A

FBC
PV
HbA1c
Renin

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14
Q

Pink Blood Draw

A

Cross match
Group and hold
Coombs

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15
Q

Grey Blood Draw

A

Glucose
Lactate
Ethanol

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16
Q

What test to do before performing an ABG?

A

Allen’s Test
= occlude radial and ulnar artery, ask patient to form tight fist then release hand flat
Continue to occlude radial artery, to check the circulation of the ulnar artery

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17
Q

Recommendations around breast feeding

A

Exclusively for the first 6 months then for up to 2 years/preference alongside solids

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18
Q

Vitamin D supplement guidance for breast feeding infants

A

Given a daily vitamin D supplement from birth

From 6 months if <500ml formula supplement vitamin A, C and D

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19
Q

What is the marker for a child being overweight?

A

Over the 91st weight centile

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20
Q

Management of cow’s milk allergy

A

2-4 weeks cows milk diet exclusion trail using extensively hydrolysed infant formula

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21
Q

What % weight loss is recommended for risk reduction from co-morbidities in BMI 25-35?

A

5-10%

22
Q

Criteria for diabetes risk assessment

A
  1. Age 40 or over
  2. Age 25 or over and South Asian/Chinese, Black African, Afro-Carribbean
  3. Those with risk factors
23
Q

How does fibre decrease colon cancer risk?

A

It encourages fibre fermentation which has an anti-proliferative effect

24
Q

Use of nutrition to induce Crohn’s Disease remission

A

Exclusive enteral nutrition cam induce remission in Crohn’s

25
Q

Intestinal biopsy preparation Coeliac Disease

A

Need to have gluten for at least one meal per day at least 6 weeks prior to testing

26
Q

Examples of enteral access

A

Nasogastric tube
Gastrostomy e.g. PEG
Jejunostomy

27
Q

Parenteral access

Indications

A

Refers to the delivery of calories and nutrition into a vein
Indications = bowel obstruction, short bowel syndrome, Crohn’s disease, ulcerative colitis

28
Q

Contents of saline

Positives/negatives

A

Na+ and Cl-
Good for resus and maintenance
Can cause hypernatraemia and acidosis in large quantities

29
Q

Contents of glucose 5%

Positives/negatives

A

Contains no electrolytes, glucose is metabolised by the liver leaving water
Good for pure dehydration
Bad for resuscitation

30
Q

Contents of Hartmans

Positives/negatives

A

Na+, Cl- and K+
Closer to normal plasma than saline
Good for resuscitation and maintenance

31
Q

Contents of gelofusine/colloids

Positives/negatives

A

Contains 0.9% saline and big molecules (to exert oncotic pressure)
Can draw in water in from ECF = volume expanders

32
Q

Management of DVT

A

1st - dalteparin
Also used in prophylaxis of DVT, consider heparin in situations where risk of bleeding (easily reversed)

Can also use rivaroxaban for treatment of uncomplicated DVT

33
Q

Limb Lead Placement

A 
Ride Your Green Bike 
Right Arm - Red 
Left Arm - Yellow 
Left Leg - Green 
Right Leg - Black
34
Q

Combination results in increased risk of GI bleed

A

Warfarin and Naproxen

35
Q

Three antibiotics not used in pregnancy

A

Ciprofloxacin
Trimethoprim - 1st and 2nd semester
Nitrofurantoin - avoid at term, can cause haemolysis

36
Q

Three drugs to avoid in hepatic impairment/monitor closely

A

Diazepam
ACE inhibitors
Amlodipine

37
Q

ACE inhibitor safe to use in hepatic impairment

A

Lisinopril

38
Q

Centor Criteria

What for?

A

= tonsillar exudate, tender anterior cervical lymph nodes, absence of cough, history of fever
3/4 indicates potential group B strep infection, patient may benefit from antibiotic treatment

39
Q

Treating pain and shortness of breath at end of life

A

Use morphine

40
Q

Treating distress at end of life

A

Midazolam

41
Q

Treating nausea at end of life

A

Levopromazine

42
Q

Treating respiratory secretions at end of life

A

Buscopan

43
Q

Going from oral to SC morphine

A

Need to half the 24 hour dose

44
Q

Going from codeine to morphine

A

Divide codeine dose by 10 to give 24 hour morphine dose

45
Q

Calculating morphine breakthrough dose

A

1/6th of 24 hour dose

46
Q

Anaemia threshold for blood transfusion

A

Hb <70g/L

<80g/L if significant co-morbidity e.g. ischaemic heart disease

47
Q

Who requires irradiated blood?

A

Any history of Hodgkins lymphoma
Any history of purine analogue chemptherapy
Immunosuppressed

48
Q

Examples of purine analogue chemotherapy

A 
Fludarabine 
Azathioprine 
Cladribine 
Pentostatin 
Clofarabine 
Nelarabine
49
Q

Who requires CMV negative blood?

A

Pregnant women
Neonates
Not required at delivery, CMV takes a couple of days to transfer across the placenta so risk to foetus in delivery is small

50
Q

Mild Transfusion Reaction
Presentation
Management

A

P: isolated temperature rise (>38 or 1-2 above baseline) or rash only
Mx: slow the rate of transfusion, give paracetamol/piriton, observe closely

51
Q

Moderate Transfusion Reaction
Presentation
Management

A

P: temperature rise (>39) and other symptoms
e.g. rigors, chills, rash, flushing, collapse, pain
Mx: stop transfusion, report to transfusion laboratory

Year 4 (27 decks)

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