Specialties

Question 1

Screening for BRCA1/2

Answer 1

2 yearly from 25 to 40 then yearly from 40-50

Question 2

Screening for HNPCC

Answer 2

2 yearly from 25 to 35, then 5 yearly from 50

Question 3

Neurofibromatosis sy

Answer 3

Macrocephaly, short stature and noonan look

Question 4

Tuberous sclerosis sy

Answer 4

Epilepsy, learning difficulties and skin lesions

Question 5

Myotonic dystrophy sy

Answer 5

Cataract, muscle weakness, learning difficulties

Question 6

Amyotrophic lateral sclerosis sy

Answer 6

Muscle weakness but cognition spaired

Question 7

Huntingtons disease sy

Answer 7

Movement disorder

Cognitive cxhanges

Personality change

Depression

Question 8

Scottish Medicines consortium

Answer 8

Decide what drugs to use by cost-effectiveness

Question 9

Patient access schemes assessment group

Answer 9

Decide if expensive drugs can be used on a case by case basis

Question 10

Area Drugs and Therapeutics Committees

Answer 10

Approve drugs for local use

Question 11

Commision on Human Medicines

Answer 11

Regulation of drugs in UK

(part of Medicines and Healthcare Products Regulatory Agency

Question 12

Homeopathy

Answer 12

Toxin diluted and ingested

Question 13

Aromatherapy

Answer 13

Use of concentrated oils

Question 14

Physiology of ageing:

• renal
• CVS
• lungs

Answer 14

GFR falls

Systoilic BP increases and diastolic falls

CO falls

Vital capacity decreases

Question 15

Comprehensive geraitric history

Answer 15

Histolic approach

Question 16

Stress incontinence mx

Answer 16

1 - pelvic floor exercises

2 - duloxetine

Question 17

Overflow incontinence mx

Answer 17

Alpha blocker (tamsulosin)

Anti-androgen (finasteride)

Question 18

Urge incontinence mx

Answer 18

1 - bladder retraining

2- anti-muscurinic e.g. oxybutinin

Question 19

Delireum assessment

Answer 19

4AT

TIME

Question 20

Pharmacokinetics

Answer 20

What body does to drug

Question 21

Pharmacodynamics

Answer 21

What drug does to body

Question 22

Changes in pharmacokinetics with age:

• absorption
• distribution
• metabolism
• excretion

Answer 22

Absorption - delayed onset of action

Distribution - more fat and less muscle, decreased albumin, BBB increased permeability

Metabolism - hepatic slower

Excretion - decreased clearance

Question 23

Triad of anaesthesia

Answer 23

Hyponosis

Analgesia

Relaxation (of smooth muscles)

Question 24

GA mechanism

Answer 24

Open chlorine channels to hyperpolarise GABA neurons and make less likely to fire

Question 25

Physiology changes in GA

Answer 25

* Central * Depress CV centre * Depress respiratory centre * Periphery * Vasodilation (decreased peripheral resistance) * Venodilation (decreased veno return, decreased CO) * Paralyse cilia in lungs

Question 26

Local anaesthesia mechanism

Answer 26

Block Na channels to prevent propogation

Question 27

Risk assessment

Answer 27

ASA grading 1 - healthy 2 - mild to moderate disease 3 - severe 4 - life threatening disease 5 - morbund patient

Question 28

What medications continue as normal

Answer 28

* Most every day ones * Exceptions only anti-diabetic and anti-coagulant

Question 29

5 minimum standards of monitoring

Answer 29

ECG Oxygen sats Blood pressure End tidal CO2 (amount of CO2 breathing out) Airway pressure

Question 30

Drugs for: - onset - maintanence

Answer 30

Onset - IV (fast) or inhalation (slower) Maintain - gas or IV

Question 31

When does acute pain become chronic

Answer 31

\>3 months

Question 32

Nociceptive v neuropathic pain

Answer 32

* Nociceptive * Sharp or dull, well localised * Obvious injury * Physiological * Neuropathic * Burning, numbness, pins and needles, not well localised * Nervous system damage

Question 33

What stimulates pain receptors

Answer 33

Prostglandins and substance P released during tissue injury

Question 34

Pain travels in what kind of nerves

Answer 34

Aδ or C

Question 35

Pain ascends in what tract

Answer 35

Spinothalamic, going contralateral to thalamus

Question 36

Modulation of pain

Answer 36

* Gate theory of pain * Descending pathway from brain to dorsal horn decreases painsignal * Rubbing, massaging or heat stimulates large Aa/AB fibres that inhibit pain signal

Question 37

Pain ladder

Answer 37

* 1 simple * NSAID, paracetomol * 2 weak opiods * Codeine * Dihydrocodeine * Tramadol * 3 strong opiods * Morphine * Oxycodone * Fentanyl

Question 38

RAT approach to pain

Answer 38

Recognise Assess severity and type Treat

Question 39

Level 1, 2 and 3 care

Answer 39

1 - ward 2 - used to be called high dependency unit, single organ support 3 - intensive care, multiorgan support

Question 40

How much oxygen can be given on ward

Answer 40

Up to 15L/min

Question 41

How much oxygen can be given in critical care

Answer 41

Up to 70L/min, 100% oxygen

Question 42

Classification of shock

Answer 42

* Distributive - blood going wrong place * Hypovolemic * Anaphylactic * Neurogenic - blood vessels abnormally dilated or pump failure * Cardiogenic - heart failure

Question 43

What determines SV

Answer 43

Preload, contractility and afterload

Question 44

Shock mx

Answer 44

Vasopressors - increase preload (cause venoconstriction) Inotropes - increase contractility Fluids

Question 45

Normal plasma osmolarity

Answer 45

298MSML/L

Question 46

Dairy requirement: - water - sodium - potasium

Answer 46

Water 30ml/kg Na and K 1mmol/kg

Question 47

Cell in hypertonic solution

Answer 47

Water leaks so shrinks

Question 48

Cell in hypotonic solution

Answer 48

Water enters so bursts

Question 49

Never give more than what amount of fluid per hour

Answer 49

\>100ml/kg/hour

Question 50

Fluid for maintanence

Answer 50

0.18%NaCl/4% glucose/0.3%KCl If K already \>5 then dont give K

Question 51

Fluid to give for replacement

Answer 51

Plamalyte If upper GI bleed give 0.9%NaCl with KCl

Question 52

Fluid for resuscitation

Answer 52

Plasmalyte 148/colloid/blood