Endgame 2

Question 1

Which chemotherapeutic causes pulmonary related side effects

Answer 1

✅ Bleomycin
🫁 Pulmonary toxicity is its hallmark adverse effect.
💥 Key facts:

Bleomycin is known to cause:
Pneumonitis (early sign)
Pulmonary fibrosis (serious, potentially irreversible)
Occurs in up to 10% of patients, especially at cumulative doses >400 units
Risk factors: Older age, renal impairment, high oxygen exposure (e.g. during surgery), chest irradiation

Question 2

First line in severe UC in hospital

Answer 2

IV corticosteroids

Question 3

First line laxative for 11 year old child with constipation

Answer 3

macrogol 3350

Question 4

Fluoxetine washout period

Answer 4

5 weeks

Question 5

How long to see improvement in MOOD with citalopram

Answer 5

4 weeks

Question 6

How many weeks to wait before drinking after stopping a MAOI

Answer 6

Once the MAOI is fully cleared (usually within 14 days after stopping, the standard washout before starting other serotonergic drugs), patients can generally resume normal alcohol consumption.
However, caution is still advised during treatment and immediately after stopping, especially avoiding tyramine-rich alcoholic drinks (e.g., red wine, beer, sherry) to prevent hypertensive crisis.

Question 7

NSAIDS with highest risk of GI effects

Answer 7

Piroxicam
Ketoprofen
Ketorolac

Question 8

NSAIDS with a moderate risk of GI effects

Answer 8

Indometacin
Dicolofenac
Naproxen (>1g a day)
Ibuprofen (>1.2g a day)

Question 9

Nsaids with lowest risk of GI effects

Answer 9

Ibuprofen less than 1.2g a day
Naproxen less than 1000mg a day

Question 10

Fidaxomicin dose

Answer 10

200mg BD for 10 days

Question 11

Which drugs can be detected on road side screening devices by the police

Answer 11

• Amfetamine
• Clonazepam
• Diazepam
• Flunitrazepam
• Lorazepam
• Methadone
• Morphine (codeine, tramadol)
• Oxazepam
• Temazepam

All Calm Drugs Feel Like Magic Medicine, Opening Thoughts

Question 12

Missed MTX DOSE

Answer 12

Within 2 days- take missed dose and then take next dose as normal

3+ DAYS-Contact dr

Question 13

Dose regimen for cellulitis for flucox

Answer 13

1-2g QDS for 5-7 days
Alternatives would be clarithromycin 500mg BD 5-7 days or erythromycin 500mg QDS for 5-7 days

Question 14

Cellulitis near the eyes treatment

Answer 14

Co-amox

Use clarithromycin with metronidazole if allergic to penicillins

Question 15

Which chemotherapeutics are mildly emetogenic

Answer 15

• Flurouracil
• Etoposide
• MTX

Question 16

Which chemotherapeutics are moderately emetrogenic

Answer 16

• Taxanes
• Doxorubicin
• Intermediate- low doses of cyclophosphamide
• Mitoxantrone
• High doses of MTX

Question 17

Which chemothereuptics are highly emetogenic

Answer 17

• Cisplatin
• dacarbazine
• High doses of cyclophosphamide

Question 18

Isotretinoin counselling points

Answer 18

• Dry eyes are Relieved by application of a lubricating eye ointment
• 1 month before starting, throughout and one month after for contraception
• More frequent checks of serum values and blood glucose are required in diabetics
• Anaemia is a common side effect

Question 19

How long to withdraw pregabalin for

Answer 19

Should be tapered for at least one week

Question 20

Metformin and surgery

Answer 20

Discontinue at the time of surgery and restart 48 hours after surgery if normal function has been established

Question 21

Which chemotherapy agent is not associated with bone marrow suppression

Answer 21

• Bleomycin
• Vincristine

Question 22

What is first line in psorarisi

Answer 22

Offer topical treatment including emollients, topical corticosteroids, coal tar preps and topical vitamin D

Question 23

Key sign of pyelonephritis and what to give in pregnancy

Answer 23

Back pain, flu like symptoms, nausea and vommiting, myalgia, high temp

Give cefalexin

Question 24

What to do if renal impaired and on 10mg of ramipril

Answer 24

Reduce dose max 5mg if between 30-60 and max 1.25mg if below 30

Question 25

Which pain relief is best in chronic kidney disease requiring haemodialysis

Answer 25

OXYCODONE Morphine is metabolised to morphine glucuronide which accumulates in renal impairment, resulting in CNS depression. Similarly, the clearance of codeine, and its metabolites are significantly reduced in renal impairment. The pharmacokinetics of oxycodone is also affected in renal failure, however it may be p referred to morphine in some circumstances. The BNF recommends to avoid codeine in renal failure and to use morphine and oxycodone with caution. The BNF also recommends to avoid ibuprofen (systemic NSAID) in severe renal impairment. Fentanyl patches and sl ow release tablets are not appropriate for a cute pain due to their slow onset of action and long duration of action.

Question 26

What does microcytic anaemia mean and what is a common cause

Answer 26

Low MCV Iron deficiency anaemia

Question 27

You are conducting a consultation with your p atient, a 40 - year - old - man, and he mentions he has recently been diagnosed with diabetes. After gaining his consent you test his blood glucose levels, the result is 3.7 mmol/L. Which ONE of the following is the most appropriate next step? Select one: A. Advise him to ea t some of his diabetic chocolate which he has bought with him B. Ask him to immediately drink some of his fruit juice that he has got with him C. Ask the patient if they took their medicines for diabetes this morning as the glucose level is quite high D. Nothing is needed, as that reading is normal, continue with the review E. Refer him to his doctor as his diabetic medication is not keeping his blood glucose levels low enough

Answer 27

A blood glucose level of 3.7 mmol/L is below the normal range and indicates hypoglycaemia (typically defined as <4.0 mmol/L). Hypoglycaemia management: The appropriate immediate response is to provide a fast-acting carbohydrate (e.g., fruit juice, glucose tablets, sugary drink). Fruit juice is a suitable and effective treatment for mild hypoglycaemia in a conscious patient.

Question 28

What is first line for allergic rhinitis

Answer 28

Nasal saline solution

Question 29

What analgesic is contraindicated in severe HF and cautioned in HF

Answer 29

Naproxen

Question 30

What reduces the absorption of levothyroxine

Answer 30

calcium and vitamin D

Question 31

Pregnant and avoiding people with chickenpox

Answer 31

avoid for at least 2-3 weeks

Question 32

What happens if you measure someone's lithium level before 12 hours

Answer 32

Taken too soon and therefore the concentration could be higher than the actual concentration

Question 33

When are patches preferred than tablets in HRT

Answer 33

in obesity due to risk of VTE

Question 34

When would you opt for cyclical HRT

Answer 34

🔄 Cyclical (Sequential) HRT When to use: If had a period in last 12 months Perimenopausal women or those who have had a natural menopause within the last 12 months. Women under 50 who still have some endogenous ovarian activity. What it involves: Oestrogen is given daily. Progestogen is added cyclically (e.g., for 12–14 days per month), leading to a monthly withdrawal bleed. Rationale: Mimics the natural menstrual cycle. Reduces the risk of endometrial hyperplasia from unopposed oestrogen.

Question 35

When is Continous HRT used

Answer 35

🔁 Continuous Combined HRT When to use: Postmenopausal women, typically those who are: Over 54 years old, or More than 12 months amenorrhoeic (without a period). Sometimes used earlier (e.g. from age 51+) if woman is clearly postmenopausal. What it involves: Oestrogen and progestogen taken together daily with no break — no withdrawal bleeding. Rationale: Avoids bleeding altogether (desirable in long-term postmenopausal care). Still protects the endometrium from unopposed oestrogen.

Question 36

What to give someone to clear the bowels prior to a colonoscopy

Answer 36

Magnesium citrate and sodium picosulfate. Sodium picosulfate is a stimulant laxative and magnesium citrate enhances its affect and also has laxative properties of its own

Question 37

What electrolyte does cisplatin disturb and how to treat

Answer 37

Cisplatin can cause hypomagnesia and patients are routinely prescribed magnesium aspartate sachets to maintain serum magnesium levels. Cisplatin is less likely to cause a decline in potassium and calcium.