Tophat Quiz

Question 1

You are called to a patient in A&E admitted with a mixed drug overdose. On examination the patient is unarousable, with pinpoint pupils and a respiratory rate of 4. After administration of 400 micrograms of IV naloxone the patient awakens suddenly and is clearly in distress. What is the mechanism of action of naloxone?

Answer 1

Competitive opioid receptor antagonist

Question 2

A 72 year old man admitted with a Myocardial Infarction is approaching discharge. Which of these is NOT a drug to be started or continued in the community as part of Secondary prevention of CVD?

Answer 2

Digoxin

Question 3

A 19 year old man presents to ED with a generalised tonic-clonic seizure. The paramedics report that he received buccal midazolam and IV lorazepam in the ambulance. The seizure is still ongoing. What is the most appropriate next stage in management?

Answer 3

Buccaneers midazolam

Question 4

A 60 year old male with known hypertension has recently had to add an additional medication due to poor control with an ACEi and calcium channel blocker. He presents with an acute onset pain and swelling in his 1st metatarsophalangeal joint of the right foot. Which of his current medications is most likely to have caused this pain and swelling?

Answer 4

Bendroflumethiazide

Question 5

A 75 year old woman has come to the GP with her partner, who is concerned about her having started gambling. Which of her medications may have precipitated this change in habits?

Answer 5

Co-careldopa (increases dopamine which is involved in reward system of behaviour)

Question 6

What is the order of selectivity of COX inhibitors from least to most COX-2 selective?
Celecoxib diclofenac ibuprofen aspirin

Answer 6

Aspirin
Ibuprofen
Diclofenac
Celecoxib

Question 7

70 year old gentleman presents with severe temporal headache, lethargy, jaw claudication and has difficulty combing his hair. Blood test results: CRP 40, PV 1.94 and ESR 64. No visual symptoms. He was diagnosed with Giant Cell Arteritis (GCA). PMH: Nil, No allergies. What is the recommended first line treatment?

Answer 7

Prednisolone (corticosteroid)

Question 8

What is the mechanism of action of formoterol?

Answer 8

Long acting beta adrenoceptor agonist (LABA)

Question 9

Mr Z has an annual Diabetic review which reveals a high HbA1c of 7.9%.
He is prescribed a new medication for his Diabetes to improve overall glycemic control. Drug X is highly lipophobic, taken intramuscularly, metabolised by the Kidneys and Liver, and cleared by the Kidneys.
PMH: Crohns, CKD3, alcoholic liver disease. In Mr Z, which 2 factors will most determine the amount of drug that remains in the body?

Answer 9

Metabolism and Elimination
Factors: CKD (elimination) and liver disease (metabolism)

Question 10

Ms. Francis has had Rheumatoid Arthritis for 30 years and has been on many different anti-rheumatic medications during this time. At present, she and her Rheumatologist have settled on a regime with 2x DMARDs and Prednisolone 20mg OD.
She strongly wishes to come off the Prednisolone. What advice would you give her when coming off the Corticosteroid medication?

Answer 10

Titrate carefully with a clinician- need to gradually reduce to allow body to start producing steroid based hormones endogenously again.

Question 11

For a drug which demonstrates 1st order kinetics, how long will it take to reach a state where the rate of administration is equal to the rate of elimination?

Answer 11

4-5 half lives

Question 12

A 53 year old has just been to see their diabetologist. It is agreed that the patients TIIDM medication will be escalated and dapagliflozin will be added. What is the mechanism of action?

Answer 12

Competitive reversible inhibition of SGLT-2

Question 13

Ben is a 24y/o man who has attended his annual asthma review with the specialist asthma nurse prescriber. He complains of disturbed sleep due to a nocturnal cough. He is otherwise well, completing sentences in one breath and with observations that are within normal range.
Ben’s asthma medication includes:

• Salbutamol inhaler 1-2 puffs as needed
• Beclomethasone inhaler 2 puffs BD.

According to NICE guidelines, which medication should be added to Ben’s regimen to improve his asthma control?

Answer 13

Montelukast (LRTA)

Question 14

A 64 year old man presents to A&E with nausea and vomiting. A diagnosis of viral gastritis is made. His PMH includes Parkinson’s disease and hypertension. After receiving an anti-emetic, he becomes slow and stiff.
Which antiemetic is most likely responsible for his neurological deterioration?

Answer 14

Metoclopramide

Question 15

A 64 year old man presents to A&E with nausea and vomiting. A diagnosis of viral gastritis is made. His PMH includes Parkinson’s disease and hypertension. The patient’s routine biochemistry shows a potassium of 2.4mmol/L (normal 3.5-5.0mmol/L).

Which of his current drugs (co-careldopa, selegiline, bisoprolol, bendroflumethiazide, lisinopril) is most likely to contribute to hypokalaemia?

Answer 15

Bendroflumethiazide

Question 16

A 68-year-old woman presents to your GP practice complaining of recurrent nose-bleeds over the last 3 days. On further questioning, she also notes she seems to bruise more easily. She denies any red-flag symptoms, such as weight-loss, fever, or pain.
She is Penicillin allergic.
The only past-medical history of note is Atrial Fibrillation, which has been managed with Warfarin for the last 2 years; last INR 2 months ago = 2.5.
She also notes she had to attend A&E 4 days ago due to suffering a dog bite, for which she was prescribed a couple of antibiotics, although she can’t remember their names. Which antibiotics are most likely to have contributed to the presenting complaint? Why?

Rifampicin metronidazole ciprofloxacin co-amoxiclav

Answer 16

Metronidazole or ciprofloxacin
Both drugs are CYP inhibitors which potentiate effects of warfarin, by reducing metabolism and increasing plasma concentration of warfarin

Question 17

A 47-year old man attends his GP for a follow-up appointment. He was reviewed 6 months ago and was found to have primary hypercholesterolaemia. He made significant lifestyle changes to reduce his cardiovascular risk, engaging regularly in the support schemes which the GP referred him to. Despite this, his cholesterol remains high and his Q-risk score is just above 10%.
What would be the most appropriate next step for the GP to suggest?

Answer 17

Commence treatment with a low dose statin ie atorvastatin (20mg OD)

Question 18

Mr Jones, a 64-year-old with Type 2 diabetes, presents to his GP for a diabetic review. His latest HbA1c is measured at 58mmol/mol (7.5%) despite being on Metformin 1mg BD for the last year. The GP decides to trial gliclazide, a sulphonylurea hypoglycaemic agent, to improve glycaemic control.
What is the primary mechanism of action of gliclazide?

Answer 18

Stimulates pancreatic insulin secretion