Third year revision

Question 1

What is the blood pressure target in pregnancy?

Answer 1

150/90

or 140/90 if they have diabetes, CKD etc.

Question 2

What is the BP target in elderly?

Answer 2

150/90

Question 3

What is the BP target in diabetes?

Answer 3

130/80

Question 4

What is stage 2 hypertension defined as?

Answer 4

160/100

Question 5

What antihypertensives are suitable in pregnancy?

Answer 5

Labetolol, methyl dopa and nifedipine

Question 6

What is the target cholesterol level?

Answer 6

Total cholesterol <5mmol/L

Question 7

Are statins appropriate for use in pregnancy?

Answer 7

NO

Question 8

Outline the secondary prevention of angina

Answer 8

75mg Aspirin
80mg Atorvastain
ACEI
Short-acting nitrate (GTN spray) and BB/CCB

Question 9

What is the difference between acute and chronic pain?

Answer 9

Chronic pain lasts over 3-6 months

Question 10

How can we assess pain?

Answer 10

Verbal rating scale, numeric rating scale (1-10), visual

Question 11

Outline the WHO analgesic ladder

Answer 11

Step 1. - NSAIDs, Paracetamol, Aspirin
Step 2 - weak opioids (codeine, oxycodone, tramadol)
Step 3- strong opioids (morphine, fentanyl)

Question 12

If NSAIDs are CI then what is a suitable alternative?

Answer 12

Weak opioid

Question 13

What dose of morphine should an opioid naieve patient be initiated on?

Answer 13

20-30mg

Question 14

What dose of morphine should a non opoid naive patient be started on?

Answer 14

30-40mg

Question 15

If a patient cannot tolerate morphine, what should be given instead?

Answer 15

Consider giving oxycodone

Question 16

How should break through pain be managed?

Answer 16

Give 1/10th to 1/6th of the total daily dose

Question 17

How should morphine doses be titrated?

Answer 17

Increments of morphine should not exceed 1/3 to 1/2 of the total daily dose every 24 hours.

Question 18

How can VTE risk be reduced in a patient taking COC with planned surgery?

Answer 18

NICE advises stopping oestrogen containing pill 4 weeks before elective surgery.

Question 19

What EHC is best for patients overweight?

Answer 19

If oral then Ulipristal is more efficacous. However IUD is most effective

Question 20

Who can we not use the cockcroft gault equation for?

Answer 20

Should not be used in patients with extensive burns of those with fluid overload - HEART FAILURE

Question 21

If a patient is taking an ACEi and they are vomiting/diarrhoea what advice would you give them?

Answer 21

Stop taking ACEI until better, need to maintain hydration

Question 22

What is ACR test?

Answer 22

Albumin:creatine ratio - used to test for proteinurea and therefore kidney failure

If ACR is >3mg/mmol then it is regarded as clinically important.

Question 23

What ACR value is regarded as clinically important in terms of kidney failure?

Answer 23

ACR >3mg/mmol

Question 24

How should pain be managed in someone with liver impairment?

Answer 24

Paracetamol is preferred

NSAIDs increase bleeding risk
Opioids increase sedation and constipation so can worsen encephalopathy

Question 25

PPI and broad spec antibiotics increase the risk of what?

Answer 25

C.diff

Question 26

How should C.diff be managed?

Answer 26

Important to stop all unnecessary antibiotcs Fluid and electrolyte replacemnet Metronidazole or vancomycin

Question 27

What pharmacogical agents can be used to manage diabetes in pregnancy?

Answer 27

Metformin and insulin. | All other oral agents should be stopped.

Question 28

What dose of folic acid is advised in pregnant diabetics?

Answer 28

Should have the higher dose - 5mg.

Question 29

Are BB safe for the management of symptom control in hyperthyroidism if the patient is diabetic?

Answer 29

Safe for short term use

Question 30

What anti asthmatic drug should not be started in pregnancy?

Answer 30

Leukotriene antagonists. | If patient is already taking and it is considered essential then they can continue.

Question 31

Opioid induced constipation should be treated with what?

Answer 31

Avoid bulk forming laxatives. Treat using stimulant or osmotic.

Question 32

Constipation that has failed to be treated with diet and lifestyle should be treated with what type of laxative?

Answer 32

1st line - bulk forming (unless opioid induced) e.g. isphagula husk 2nd line - Osmotic, macrogels and then lactulose 3rd - stimulant e.g. senna, docusate