medicine SCE

Question 1

Levodopa

Answer 1

Monoamine endogenous compound used to treat Parkinson’s disease

Question 2

Carbidopa

Answer 2

A Peripheral decarboxylase inhibitor which reduces the symptoms of peripheral levodopa metabolisation

Question 3

Benserazide

Answer 3

A Peripheral decarboxylase inhibitor which reduces the symptoms of peripheral levodopa metabolisation

Question 4

Co-careldopa (SINEMET)

Answer 4

A pre-packaged combination of levodopa and carbidopa

Start dose 25 (decarboxylase inhibitor) / 100 (L-Dopa) and double every 2 weeks.

Question 5

Co-Beneldopa (MADOPAR)

Answer 5

A pre-packaged combination of levodopa and benserazide to treat Parkinson’s centrally with levodopa and combat peripheral side effects with the decarboxylase inhibitor

Start dose 25 (decarboxylase inhibitor) / 100 (L-Dopa) and double every 2 weeks.

Question 6

Domperidone

Answer 6

• Domperidone is a peripherally selective dopamine D2 and D3 receptor antagonist.
• It has no clinically significant interaction with the D1 receptor, unlike metoclopramide.
• The medication provides relief from nausea by blocking D2 receptors in the chemoreceptor trigger zone at the floor of the fourth ventricle

Question 7

Entacapone

Answer 7

COMT inhibitor which blocks the coversion of levodopa to 3-0-methyldopa.

This increases the efficacy of levodopa giving more bang for your buck. Obviously you have to have levodopa in the system for it to work…

Question 8

Stalevo

Answer 8

A pre-packaged combination of co-careldopa (levodopa and carbidop) and entacapone.

Question 9

Selegiline

Answer 9

Selegiline is a selective inhibitor of MAO-B, irreversibly inhibiting it by binding to it covalently. It prevents the breakdown of dopamine to homovanillic acid, thus increasing its activity.

Question 10

Rasagiline

Answer 10

Rasagiline is a selective inhibitor of MAO-B, irreversibly inhibiting it by binding to it covalently. It prevents the breakdown of dopamine to homovanillic acid, thus increasing its activity.

Question 11

Ropinerole

Answer 11

Dopamine analogues. Not as good as levodopa. Also make old people randy and risky (don’t give to gamblers or addicts).

Question 12

Rotigotine

Answer 12

Transdermal dopamine analogue. Only use if you can’t get an NG down a Parkinson’s patient or use levodopa alternatives

Question 13

Koebner’s phenomenon

Answer 13

the appearance of skin lesions on lines of trauma.

Question 14

Adult onset Still’s disease

Answer 14

Major:

• Temperature of 39 Celsius for more than one week.
• Neutrophilic white fell count >10
• rash
• arthralgia >2/52

Minor

• Sore throat
• LN enlargement
• Splenomegaly
• Liver Dysfunction
• Negative ANA/RF

Need 5 or more, at least 2 major

Question 15

Eosinophilic granulomatosis with polyangiitis (Churg Strauss) Criteria

Answer 15

• asthma
• eosinophilia >10%
• paranasal sinusitis
• pulmonary infiltrates
• histological proof of vasculitis with extravascular eosinophils
• mononeuritis multiplex or polyneuropathy

Need four from 6

Typically renal involvement, and pANCA raised (anti MPO +ve)

Question 16

Felty’s syndrome

Answer 16

Splenomegaly and neutropaenia in a patient with RA. Associated with HLA-DR4 (95% vs 50% in the general RA population

Question 17

Colchicine

Answer 17

Anti-inflammatory used in gout and Behçet’s disease when NSAIDs can’t be tolerated.

Possibly works by disrupting mitosis and neutrophil migration to site of inflammation.

Question 18

Rasbicurase

Answer 18

Recombinant urate oxidase: an enzyme that metabolises uric acid to allantoin, which humans don’t have.

It’s used to prevent Tumour Lysis Syndrome in treatment of lymphoma and leukaemia

Question 19

Febuxostat

Answer 19

Non-purine selective inhibitor of xanthine oxidase.

Used to treat hyperuricaemia when allopurinol is contraindicated such as allergy or mild-moderate renal impairment

Question 20

When to refer for spondyloarthritis assessment?

Answer 20

Back pain <45yo, >3/12:
>4 of;

• Low back pain <35
• Waking from sleep due to pain
• buttock pain
• improvement with movement
• improvement with NSAIDS
• first degree relative with spondyloarthritis
• current or past arthritis
• current or past enthesitis
• current or past psoriasis

Question 21

Etanercept

Answer 21

Anti-TNFa therapy used in several rheumatological conditions.

Can mask infection so stop if any suspicion

Question 22

Fat Embolisation syndrome Criteria

Answer 22

Major
Resp symptoms
Petechial rash
Cerebral signs
Radiological disease 

Minor
Tachycardia >110
^ESR
T >38.5C
Fat globules in retina
Acute drop in Hb /platelets
Renal Dysfunction
Acute Jaundice