VLE questions I got wrong/unsure on Flashcards
Because this vitamin is fat soluble, patien’ts siffering from fat soluble malabsorption may become deficient and present with easy bruising or bleeding gums. What is the vitamin?
Vit A
Vit B
Vit C
Vit D
Vit K
vitamin k
which of the following is not a common side effect of atenolol?
a. bradycardia
b. coldness of extremities
c. fatigue
d. fine tremour
e. headache
d. fine tremour
Mr DS is a 94-year old man admitted with confusion due to a urinary tract infection. His long-term catheter has blocked as a result and he has a serum creatinine level of 547 micromol/L (49-90) and a serum potassium of 6.4 mmol/L (3.5-5.0) with ECG changes.
what’s the most appropriate intial treatment for hyperkalaemia?
a. calcium gluconate injection
b. calcium resonium orally
c. haemodialysis
d. insulin and glucose infusion
e. nebulsied salbutamol
a. calcium gluconate
All are included in hyperkalaemia treatment but calcium gluconate needed as a priprity to protect cardiac function in view of ECG changes.
See treatment of hyperkalaemia in adults NICE
Mrs C is 75 years old and is being treated a two-week course of co-amoxiclav 375mg three times daily. When collecting her repeat prescription she mentions having dark urine, pale stools and feeling tired and nauseated for the last week. She wonders if her antibiotic is to blame.
What is the most appropriate advice to be given to Mrs C?
a.The symptoms described are not known to be caused by co-amoxiclav
b.She should see her GP as she may need to reduce the frequency of co-amoxiclav
c. She should see her GP as the dose of co-amoxiclav may need to be increased
d. She is experiencing a side-effect of co-amoxiclav, and whilst safe to continue taking it, she may wish to see her GP for an alternative
e. She should stop taking co-amoxiclav and seek medical attention as soon as possible
Answer = e; She should stop taking co-amoxiclav and seek medical attention as soon as possible
These are symptoms of liver dysfunction and so need reviewing asap.
See BNF > co-amoxiclav >cautions
Regarding the use of long acting beta2 agonists for the management of asthma, which of the following is NOT true?
a. - They should be added to therapy if use of inhaled short acting beta 2 agonists alone has failed to control asthma adequately
b. - They should be discontinued in the absence of any benefit
c.- They should be introduced at a low dose
d. - Patients should report any deterioration in symptoms following initiation of treatment
e. - They should NOT be initiated in patients with rapidly deteriorating asthma
Answer = a; They should be added to therapy if use of inhaled short acting beta 2 agonists alone has failed to control asthma adequately
LABA should be used if low dose ICS and LTRA not worked
Which of the following is not a side-effect of amiodarone?
a. - Dry mouth
b. - Hyperthyroidism
c. - Hypothyroidism
d. - Jaundice
e. - Taste disturbance
a. - Dry mouth
what abx would you not recommend for pt with eGFR 35ml/min?
a. amoxicillin
b. azithromycin
c. clarithromycin
d. doxycycline
e. oxytetracycline
e. oxyetracycline - avoid in renal failure
Mr AK has decompensated liver disease secondary to alcoholic liver disease. His regular medications include ursodeoxycholic acid 250mg twice daily, colestyramine 4g at night, spironolactone 100mg once daily and citalopram 20mg once daily. He is complaining of bone pain.
Which of the following is a suitable analgesic for Mr AK?
a. codiene phosphate
b. ibuprofen
c. oramorph
d. paracetamol
e. tramadol
Answer = d; paracetamol
Paracetamol is safest option, although large doses can cause dose-related toxicity. All opioids listed can accumulate and cause respiratory depression/other opioid SE. Ibuprofen can cause exacerbate fluid retention and so oedema/ascites. Possible interaction between citalopram and tramadol too so avoid (in addition to opioid issue).
what abx isn’t suitable for an epileptic patient taking carbamazepine?
a. amoxicllin
b. ciprofloxacin
c. gentamcin
d. metronidazole
e. nitrofurantoin
ciprofloxacin - can lower seizure threshold
what abx shouldn’t be given to a pt with eGFR 45ml/min?
a. amoxicllin
b. ciprofloxacin
c. gentamcin
d. metronidazole
e. nitrofurantoin
nitrofurantoin
Cr high, Na+ low, K+ high - what drug likely to cause this?
a. digoxin
b. donepizil
c. apixaban
d. paracetamol
e. naproxen
Answer = d
Naproxen is an NSAID and as per BNF should be avoided if possible or used with caution in patients with renal impairment; the lowest effective dose should be used for the shortest possible duration, and renal function should be monitored. Sodium and water retention may occur and renal function may deteriorate, possibly leading to renal failure; deterioration in renal function has also been reported after topical use; see also individual drugs.
Apixaban and digoxin may need dose reducing as a result.
what drug class does glibenclamide belong to?
sulphonylurea
what antimicrobial reduce the action of warfarin, requiring a dose increase of warfarin whilst on this therapy?
a. cipro
b. fluclox
c. metronidazole
d. rifamicin
e. vancomycin
rifampicin - Rifampacin decreases anticoag effect of warfarin and so likely to need warfarin dose increase. Ciprofloxacin would enhance effects of warfarin and so would need a lower dose of warfarin. Flucloxacillin and metronidazole may alter effect but direction unknown.
The following patients ask to buy emergency hormonal contraception from your pharmacy. All have had unprotected intercourse.
Given that there are no other contra-indications, to which patient would it be appropriate for you to make the sale?
a. An adult woman who had unprotected intercourse 6 days ago
b. An adult woman who suffers from Crohn’s Disease
c. An adult woman whose period is 3 days late
d. An adult woman who has already taken one course of EHC within the same menstrual cycle
e. A young woman aged 15 years
Answer = d; An adult woman who has already taken one course of EHC within the same menstrual cycle
As the following criteria should be assessed when making a decision whether to supply EHC:
· If there is a possibility that the patient could already be pregnant (possibly seen by late period)
· The patient is breast-feeding
· The patient has hepatic impairment
· The patient has severe asthma
· The patient has previously had an ectopic pregnancy
· The patient has a bowel disorder that may affect absorption such as Crohn’s disease
· The patient takes anti-epileptics,medicines for epilepsy, rifamycins or St John’s Wort
Levonorgestel is licensed up to 72 hours (3 days) after unprotected sex and Ulipristal up to 120 hours (5 days), therefore 6 days is outside of license.
what are the directions to use a GTN spray?
400 - 800mcg (1 - 2 sprays) under the tongue at onset of chest pain. Repeat 5 mins later if symptoms not resolved after 3 doses call 999
how many hours need to pass before a missed dose of desogestrel?
12
what does Pro B-type natruretic peptide tests show?
measues cardiac function and will be raised in heart failure
if patient have folate deficiency, what dose and duration of folic acid do they receive?
5mg OD for 3 months
if a pt comes into community and has hurt their foot playing football, has PMH of asthma and on PPI, what is the best action?
paracetamol and rest - NSAIDs contraindicated in asthma/COPD and probs not best of on PPI
what could be the diagnosis if pt struggling to pass stool and sharp pain when passing stool with blood sometimes in the toilet?
anal fissure
can be described as tear
what is euglycaemic DKA?
What should you do if someone presents with it?
- triad of increasing anoin gap (metabolic acidosis)
- ketonemia or ketouria
- normal blood glucose
- considered serious SE of SGLT2i
- stopo SLGT2i and go to hospital
what are the symptoms of neutropenic sepsis and where should you refer?
fever, lethargic, going hot and cold
refer to A&E
how do you manage someone on phenytoin who is also on enteral feeds due to significant weight loss?
receiving feeds will mean phenytoin levels are lower than expected - reducing seizure threshold
therefore must interrupt feeds for 2 hours before and after phenytoin dose
where should you refer a diabetic foot seen in community if its an option?
foot protection
can trimethoprim be used in pregnancy?
no
at what stage can nitrofurantoin be used in pregnancy?
up to 36 weeks, after this must be avoided
what antiepiletic is associated with a risk of overheating and dehydration?
zonisamide
what can you do to manage menengitis if someone has a penicllin allergy
cefotaxime
what is the only antihypertensive in pregnancy?
labetolol
what age can you sell naproxen OTC from?
15 yrs - 50 yrs
what age is sumatriptan licensed for OTC?
18 - 65 years
What does measeles in he mouth look like?
grey, white spots
what SE do people often report with hydroxychloroquine?
visual distrubances
what symptom would you be concerned about following an increase in metformin dose?
muscle cramps - suggests lactic acidosis risk
what should you do if a pt has tried gaviscon for indigestion but this hasn’t helped?
trial PPI for 14 days
what formaultion should air be added to to aid removal of the liquid?
bottle
why can miconazole now be given to 5 month old?
due to POM - P switch
when should a patient take sildenafil?
before food
how long does someone need to wait after taking EllaOne to breastfeed?
can breast feed straight away as not excreted in breast milk
what should you do if you see a seretide 50 evohaler for a 3yr old?
contact prescriber to discuss supply of off label medicines
which of the following is not a legal requirement for NHS scripts?
- dose
- prescriber details
- ages in under 12
- formulation
- strength
dose
whats the MHRA warning for lidocaine?
do not apply more than 6 times a day
before what test should someone remove a nicotine patch?
MRI
what pt would be suitable for warfarin - dabigatran switch?
- recent GI ulcer
- malignant neoplasams
- surgery
- prosthetic valve
- diabetic
diabetic
what is capecitabine?
antimetabolite
whats a differential diagnosis of lidoystrophy?
cutaneous amyloidosis
when counselling a pateint on selegiline, how can you explain the rationale behind the driving laws?
due to its metabolism
what does sputum look like in someone with bronchiectasis?
purulent - thick, yellow, green
