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COTE Flashcards

1
Q

How is the diagnosis of postural hypotension made?

A

Drop in systolic of 20 or diastolic of 10 after standing

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2
Q

3 medications that can cause postural hypotension

A

Furosemide, bendroflumethiazide
Tamsulosin
Calcium channel blockers, ACE inhibitors

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3
Q

Other than medication, give 2 possible causes of postural hypotension

A

Parkinsons
T2DM
Aortic stenosis

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4
Q

Give 2 non-pharmacological management options for postural hypotension

A

Increasing salt and fluid intake
Avoiding sudden sitting to standing, prolonged standing etc
Compression stockings or abdominal binder (to reduce venous pooling)
Physical activity (to reduce venous pooling)

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5
Q

Give 2 drugs used to manage postural hypotension

A

Fludrocortisone
Midodrine

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6
Q

Other than postural hypotension, give 2 factors that may increase the risk of falls in the elderly

A

Polypharmacy
Arthritis
Reduced cognition
Reduced vision

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7
Q

Define delirium

A

an acute onset of cognitive deficit where the perception of reality is distorted

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8
Q

What tool can differentiate delirium from dementia

A

4AT

Alertness
A short test of orientation (cognition)
Attention (recitation of the months in backwards order)
Acute change or fluctuating course

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9
Q

Other than infection, give 3 possible causes of delirium

A

Urinary retention
Dehydration
Hypothermia
Hypoxia
Insomnia
Hepatic or renal impairment
Environmental changes / visual disturbance / hearing disturbance
Drugs (opioids / corticosteroids / anticholinergics / benzodiazepines)
Alcohol withdrawal

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10
Q

Which organisms are most commonly responsible for UTIs

A

e.coli
staph aureus

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11
Q

What is the mechanism of action of penicillin-based antibiotics?

A

Inhibit cell wall synthesis

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12
Q

How may bacteria develop resistance to penicillin-based antibiotics

A

Beta-lactamase production (break down the beta-lactam ring)

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13
Q

How do combination penicillin drugs work e.g. co-amoxiclav or tazocin

A

Beta-lactamase inhibitors

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14
Q

Other than memory loss, give 2 ways dementia may present

A

Irritability
Mood changes
Personality changes
Anorexia

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15
Q

Other than Alzheimer’s disease, give the 2 commonest causes of dementia

A

Lewy body dementia
Vascular dementia

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16
Q

Give 2 common reversible causes of dementia

A

Normal pressure hydrocephaly
B12 deficiency
Thiamine deficiency
Uraemia

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17
Q

Name 2 abnormalities seen on an MRI brain of a patient with Alzheimer’s disease

A

Frontal lobe atrophy
Hippocampal atrophy
Ventricular enlargement

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18
Q

What class of medication may be given to a patient with alzheimer’s disease and briefly explain its mechanism of action

A

Anticholinergics e.g. donepezil, rivastigmine

Inhibition of acetylcholinesterase (less ACh broken down and more available at the synapse)

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19
Q

Which group of muscles are commonly weak in women with stress incontinence

A

Pelvic floor muscles

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20
Q

Name one drug that precipitates urinary incontinence

A

Diuretics (furosemide, bendroflumethiazide)
Sedatives (opiates, antipsychotics)

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21
Q

Give 2 reasons for pelvic floor weakness

A

Pregnancy
Childbirth
Obesity
Chronic constipation

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22
Q

Name one drug that may cause urinary retention

A

Anti-cholinergics

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23
Q

Give 2 pieces of advice for stress incontinence

A

Drink less fluids

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24
Q

How does duloxetine work for stress incontinence

A

tightens the urethral sphincter

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25
A pt has recently started a new tablet, as her BP was not controlled on amlodipine, and her urinary incontinence has got worse - what is the tablet?
ACEi
26
What scoring system can be used to determine the risk of stroke in the days following a TIA
ABCD2
27
Name the parameters of the ABCD2 scoring system
Age (65 - 1, 70 -2) Blood pressure Clinical features Duration (> 60) Diabetes
28
What operation may be performed on someone with carotid artery stenosis?
Carotid arterectomy
29
Name 3 risk factors for ischaemic stroke
Smoking Obesity Hypertension
30
What is the mechanism of action of warfarin
Vitamin K antagonist
31
What is the mechanism of action of apixaban
Direct inhibitor of factor X
32
What is the mechanism of action of dabigatran
Indirect inhibitor of factor X
33
What is the mechanism of action of dalteparin
LMWH -
34
What is the mechanism of action of heparin
35
From which artery does the middle cerebral artery arise
Internal carotids
36
Facial droop, slurred speech, expressive dysphasia, right-sided facial palsy, right-sided weakness and right homonymous hemianopia Using the OCSP, what is the diagnosis?
37
What drug is commonly used for stroke thrombolysis?
alteplase
38
Give 4 absolute or relative contraindications to thrombolysis
Previous intracranial haemorrhage Active bleeding Severe uncontrolled hypertension Significant head injury within 3 months Recent intracranial surgery Ischaemic stroke within 3 months
39
Name 4 risk factors for osteoporosis
Steroids Hyperthyroidism Alcohol and smoking Thin (BMI <18.5) Testosterone Early menopause Renal/liver Erosive bone disease (myeloma, RA) Dietary low calcium/malabsorption
40
Fractured right pubic ramus (common site for osteoporotic fractures) Name 3 other sites where osteoporotic fractures often occur
NOF Elbow? Knee?
41
on a DEXA scan, what is meant by a) T score b) Z score
a) Against healthy young person b) Against matched for sex, age, ethnicity
42
Give 2 pieces of advice on how to take bisphosphonates e.g. alendronate
Sit up 30 mins before eating and drinking In the morning
43
Give 2 common side effects of bisphosphonates and 2 serious side effects
Diarrhoea, reflux Oesophageal ulcers, atypical fractures
44
What 2 investigations are requested in a myeloma screen
Urinary proteins Serum proteins
45
What characteristic abnormality may be seen on X-ray in myeloma
punched out lesions
46
Myeloma pt with difficulty passing urine and constipation, no sensation below T10 Diagnosis?
spinal cord compression
47
What drug should be started immediately in spinal cord compression
dexamethasone
48
What urgent investigation would you request for spinal cord compression
CT?
49
Give 2 management options for spinal cord compression
surgical decompression
50
Other than spinal cord compression, name 2 other possible complications of myeloma
Hypercalcaemia Acute kidney injury Anaemia
51
What is parkinsons disease
Destruction of dopaminergic neurones in the substania nigra causing motor defects
52
Give the 3 classical features of PD
Bradykinesia Cogwheel rigidity Unilateral tremor
53
Other than the classical triad, give 2 other features of PD
Hypomimica Hypoarthria
54
Name 2 other causes of PD
Drugs Lewy body
55
Why is levodepa often used in combination with another durg e.g. carbidopa
stops levodopa being broken down peripherally so it has a longer affect in the CNS
56
Features of benign essential tremor
improves with alcohol bilateral tremor worse with movement
57
Other than prostate cancer, give 2 other causes of a raised PSA
DRI BPH
58
What abnormality would you expect to see on LFTs in bone cancer
raised ALP
59
Give 2 management options for hypercalcaemia
Fluids Bisphosphonates
60
Name the 4 distressing end-of-life symptoms and name a drug for each
Agitation - haloperidol Respiratory secretions - hyoscene Constipation - laxatives Pain - morphine
61
Mechanism of action of memantine
NMDA receptor antagonist
62
Donepezil and rivastigmine mechanism of action
Acetylcholinesterase inhibitors
63
1 non-pharmacological interventions used in prevention and treatment of delirium
Reduce polypharmacy Promote good sleep hygiene Avoid dehydration Encourage early mobilisation Encourage family to visit Reorient patient Maintain environment
64
Document to make DNACPR legally binding
Advance decision to refuse treatment
65
Give two appropriate points for metastatic bone cancer discussion (aims)
1. Manage symptoms e.g. analgesia 2. Slow progression e.g. chemo 3. Improve quality of life e.g. end of life discussions such as DNACPR, ceiling of care, wishes for home or hospital
66
What is one area of palliative care that you cannot offer support or advice
Anything which would assist suicide

SAQ for finals (20 decks)

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