S17

Question 1

A patient who takes warfarin for atrial fibrillation and has an INR of >8 is admitted onto your ward. What should be given by slow intravenous injection?
Ascorbic acid
Calcium
Folic acid
Iron
Retinol
Vitamin D
Vitamin K
Zinc

Answer 1

Vitamin K (Phytomenadione) helps to counteract the warfarin action and slow down the bleeding

Question 2

This requires hydroxylation by the kidneys to its active form, therefore, in patients with a severe reduction in renal function, alfacalcidol should be prescribed instead of this.
Ascorbic acid
Calcium
Folic acid
Iron
Retinol
Vitamin D
Vitamin K
Zinc

Answer 2

Vitamin D, colecalciferol, is the non-activated form of vitamin D. It is activated in the kidneys, so if a patient has reduced renal function then the activated form (alfacalcidol) should be given instead.

Question 3

This helps the absorption of calcium in the gut.
Ascorbic acid
Calcium
Folic acid
Iron
Retinol
Vitamin D
Vitamin K
Zinc

Answer 3

Vitamin D is needed for the body to absorb calcium effectively. Unlike other vitamins, we do not need to get vitamin D from food. Most of the vitamin D we have is made by our own bodies. It is made in the skin by the action of sunlight. This is a good thing because most foods contain no, or very little, vitamin D naturally.

Question 4

Used in the prevention of a methotrexate side effect.
Ascorbic acid
Calcium
Folic acid
Iron
Retinol
Vitamin D
Vitamin K
Zinc

Answer 4

Methotrexate suppresses cells which are metabolically active. One of the ways it does this is to antagonise an enzyme involved in the metabolism of folic acid. Folic acid should be taken on the day or days when the patient does not take methotrexate

Question 5

Which of the following has a side effect that can cause stools to be darkened?
Ascorbic acid
Calcium
Folic acid
Iron
Retinol
Vitamin D
Vitamin K
Zinc

Answer 5

Iron

Question 6

You should advise pregnant patients to avoid liver products due to the fact they contain this.
Ascorbic acid
Calcium
Folic acid
Iron
Retinol
Vitamin D
Vitamin K
Zinc

Answer 6

Retinol is vitamin A which is found in large volumes in liver products, which can be harmful to the unborn baby.

Question 7

When a patient has an overload of this substance, deferasirox should be administered to the patient.
Ascorbic acid
Calcium
Folic acid
Iron
Retinol
Vitamin D
Vitamin K
Zinc

Answer 7

Indicated for the treatment of chronic iron overload when desferrioxamine is contraindicated or inadequate (with non-transfusion-dependent thalassaemia syndromes).

Question 8

Osteonecrosis of the jaw is a risk in patients who receive treatment with this drug.
Alendronate
Disulfiram
Isoniazid
Isotretinoin
Ketoconazole
Lithium
Rifampicin
Sulfasalazine

Answer 8

Alendronic acid is a bisphosphonate, and as with all bisphosphonates, osteoncecrosis of the jaw is a potential side effect of treatment with this drug.

Question 9

This drug has a narrow therapeutic range. The usual range should be between 0.4 mmol/L and 1 mmol/L.
Alendronate
Disulfiram
Isoniazid
Isotretinoin
Ketoconazole
Lithium
Rifampicin
Sulfasalazine

Answer 9

Lithium

Question 10

This drug is used in the treatment of ulcerative colitis.
Alendronate
Disulfiram
Isoniazid
Isotretinoin
Ketoconazole
Lithium
Rifampicin
Sulfasalazine

Answer 10

Sulfasalazine

Question 11

This drug has several indications including treatment of bipolar disorder.
Alendronate
Disulfiram
Isoniazid
Isotretinoin
Ketoconazole
Lithium
Rifampicin
Sulfasalazine

Answer 11

Lithium

Question 12

Patients who are newly started on this drug should be warned they may need ophthalmological referral should they develop side effects.
Desmopressin
Diazepam
Flucloxacillin
Lamotrigine
Misoprostol
Paroxetine
Salbutamol
Vigabatrin

Answer 12

Vigabatrin
As this drug may cause visual field defects, it is important that patients are aware of the need they may need eye check ups during treatment.

Question 13

This drug can be used to help treat symptoms such as depression and anxiety.
Desmopressin
Diazepam
Flucloxacillin
Lamotrigine
Misoprostol
Paroxetine
Salbutamol
Vigabatrin

Answer 13

Paroxetine
This drug is an SSRI, which is used the treatment of depression and anxiety.

Question 14

This drug can be used in the treatment of post-traumatic stress disorder.
Desmopressin
Diazepam
Flucloxacillin
Lamotrigine
Misoprostol
Paroxetine
Salbutamol
Vigabatrin

Answer 14

Paroxetine is indicated for the treatment of PTSD

Question 15

When using this drug in the treatment of epilepsy, care should be taken when switching between oral formulations.
Desmopressin
Diazepam
Flucloxacillin
Lamotrigine
Misoprostol
Paroxetine
Salbutamol
Vigabatrin

Answer 15

Different brands of this drug have varying bioavailabilities. As such, they must be prescribed brand specific formulations for individual patients. Category 2 - For these drugs, the need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with the patient and/or carer taking into account factors such as seizure frequency, treatment history, and potential implications to the patient of having a breakthrough seizure

Question 16

This medication is commonly used in the treatment of impetigo.
Desmopressin
Diazepam
Flucloxacillin
Lamotrigine
Misoprostol
Paroxetine
Salbutamol
Vigabatrin

Answer 16

Flucloxacillin
Flucloxacillin is an antibiotic. It is commonly used in the treatment of impetigo

Question 17

Patients being treated with this medication may need to be maintained on a specific manufacturer’s branded or generic product.

Desmopressin
Diazepam
Flucloxacillin
Lamotrigine
Misoprostol
Paroxetine
Salbutamol
Vigabatrin

Answer 17

Lamotrigine
Different brands of this drug have varying bioavailabilities. As such, they must be prescribed brand specific formulations for individual patients.

Question 18

This medication can be used to treat spasticity in multiple sclerosis.
Amoxicillin
Baclofen
Chloramphenicol
Chlorpromazine
Ciprofloxacin
Fludrocortisone

Risedronate sodium
Tamsulosin hydrochloride

Answer 18

Baclofen is indicated for treatment of spasticity in MS.

Question 19

This drug may be used to treat postural hypotension.
Amoxicillin
Baclofen
Chloramphenicol
Chlorpromazine
Ciprofloxacin
Fludrocortisone

Risedronate sodium
Tamsulosin hydrochlorid

Answer 19

Fludrocortisone is indicated for treatment of postural hypotension

Question 20

The use of this drug is contraindicated in patients who suffer with, or have a history, postural hypotension.
Amoxicillin
Baclofen
Chloramphenicol
Chlorpromazine
Ciprofloxacin
Fludrocortisone

Risedronate sodium
Tamsulosin hydrochloride

Answer 20

Tamsulosin may cause a reduction in blood pressure. As such, it is contraindicated in those who suffer with postural hypotension.

Question 21

This drug belongs to a group of non-hormonal medicines called bisphosphonates which are used to treat bone diseases.
Amoxicillin
Baclofen
Chloramphenicol
Chlorpromazine
Ciprofloxacin
Fludrocortisone

Risedronate sodium
Tamsulosin hydrochloride

Answer 21

Risedronate sodium is a bisphosphonate. Bisphosphonates are adsorbed onto hydroxyapatite crystals in bone, slowing both their rate of growth and dissolution, and therefore reducing the rate of bone turnover. This in turn can help prevent osteoporosis.

Question 22

Large amounts of dairy products may slow down the uptake of this drug and should not be taken concurrently.
Amoxicillin
Baclofen
Chloramphenicol
Chlorpromazine
Ciprofloxacin
Fludrocortisone

Risedronate sodium
Tamsulosin hydrochloride

Answer 22

Ciprofloxacin absorption is impacted by dairy produce. Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine.

Question 23

The use of higher dosages of this drug may cause photosensitisation, and as such, sunlight should be avoided.
Amoxicillin
Baclofen
Chloramphenicol
Chlorpromazine
Ciprofloxacin
Fludrocortisone

Risedronate sodium
Tamsulosin hydrochloride

Answer 23

Chlorpromazine may cause photosensitisation. Although ciprofloxacin can cause photosensitivity, this is not in a dose-related manner. Chlorpromazine causes photosensitivity at higher doses, which is what the question asks about so that is the appropriate answer to this question. Chloramphenicol is not associated with photosensitivity.

Question 24

This drug is a potent uterine stimulant and may be teratogenic.
Desmopressin
Diazepam
Flucloxacillin
Lamotrogine
Misoprostol
Paroxetine
Salbutamol
Vigabatrin

Answer 24

Misoprostol is a potent uterine stimulant and is not safe for use in pregnant women.

Question 25

This drug, when prescribed, should be withdrawn gradually if used for more than 2 weeks. Desmopressin Diazepam Flucloxacillin Lamotrogine Misoprostol Paroxetine Salbutamol Vigabatrin

Answer 25

Benzodiazepines can be prescribed for an array of conditions, however, they should not be prescribed for any longer than 2 to 4 weeks. This is due to the addictive nature of this drug class. They need to be withdrawn gradually if this period is exceeded.

Question 26

The overuse of this drug may result in potentially serious hypokalaemia. Desmopressin Diazepam Flucloxacillin Lamotrogine Misoprostol Paroxetine Salbutamol Vigabatrin

Answer 26

Salbutamol may cause hypokalaemia, especially if overused.

Question 27

This drug can cause cholestatic jaundice up to 8 weeks after treatment has ceased. Desmopressin Diazepam Flucloxacillin Lamotrogine Misoprostol Paroxetine Salbutamol Vigabatrin

Answer 27

Flucloxacillin can cause cholestatic jaundice. This may occur during treatment or up to 8 weeks post treatment.

Question 28

Treatment of this drug may cause visual field defects. Desmopressin Diazepam Flucloxacillin Lamotrogine Misoprostol Paroxetine Salbutamol Vigabatrin

Answer 28

Vigabatrin Patients using this drug must have regular eye checks as the use of this drug may cause visual field defects.

Question 29

Miss D, a 7-year-old girl, presents with loose stools and abdominal pain. Her parents say that she has lost weight and generally feels ‘low’. Her blood results reveal an elevated C-reactive protein and erythrocyte sedimentation rate. Coeliac disease Constipation Crohn’s disease Dyspepsia Gastro-oesophageal reflux disease Lactose intolerance Pneumonia Sepsis

Answer 29

Diarrhoea, abdominal pain and elevated CPR/ESR are suggestive of Crohn’s disease

Question 30

Mr R, a 14-year-old boy, has type I diabetes mellitus. He is presenting with oily loose stools, abdominal pain and recurrent episodes of hypoglycaemia. He tells you that he enjoys eating different types of breads. Coeliac disease Constipation Crohn’s disease Dyspepsia Gastro-oesophageal reflux disease Lactose intolerance Pneumonia Sepsis

Answer 30

Coeliac disease is caused by an adverse immune response to gluten, a protein found in wheat, barley and rye. Like type 1 diabetes mellitus, coeliac disease is also an autoimmune condition.