1
Q
Name some sulphonureas..
A
Gliclazide
Glimepiride
Glibenclamide
Tolbutamide
2
Q
Name some DPP4 inhibitors..
A
Alogliptin, linagliptin, saxagliptin, sitagliptin
3
Q
What is an impaired fasting glucose?
A
After fasting glucose is between 6.1 and 7 mmol
If above 7 ?diabetes
4
Q
What is impaired glucose tolerance?
A
2 hour value between 7.8 and 11.1
5
Q
How often should HBA1C levels be measured in type 2 diabetes?
A
Every 2-6 months until stable
Then every 6 months
6
Q
What are reed sternburg cells characteristic of?
A
Hodgekins lymphoma
7
Q
What is the most common type of Hodgkin’s lymphoma?
A
Nodular sclerosing
8
Q
What deciles is Hodgkin’s most common in?
A
3rd
7th
9
Q
What type of Hodgkin’s is associated with lacunar cells?
A
Nodular sclerosing
10
Q
What are the B symptoms in Hodgkin’s?
A
Weight loss over 10% in 6 months
Fever above 38
Night sweats
11
Q
What 3 things on an X-ray suggest COPD?
A
Hyperinflation
Flattened hemidiaphragms
Hyperlucent lung fields
12
Q
What is neoadjuvent chemotherapy?
A
Used to reduce tumour size before planned surgical intervention
13
Q
What is primary chemotherapy?
A
Where it is in operable but the chemo may lead to possible surgery
14
Q
What is adjuvent chemotherapy?
A
Chemo after surgery to treat occult microscopic metastasis
15
Q
Give and example of prophylactic chemotherapy?
A
Tamoxifen for insitu breast ca before invasive carcinoma is seen
16
Q
How are chemotherapy doses calculated?
A
Using body surface area
17
Q
What are the principles of chemotherapy?
A
Administer drugs in combinations
Give tx in cycles
Administer optimal dose
Only use maintenance when necessary
18
Q
What cancers is chemo really good in? (Over 50% cure)
A
Hodgkin’s
Testicular ca
ALL
Paeds ca (leukaemia, lymphoma, sarcoma)
19
Q
When might single dose chemo be appropriate?
A
In palliative care as it is rarely curative
20
Q
What are the main aims of combination chemotherapies?
A
Maximise cell kill
Minimise toxicity in non -tumours cells
Minimise development of resistance
21
Q
How do you minimise the toxicity of chemo?
A
Give drugs where their toxic side effects don’t overlap
Give chemo in cycles
22
Q
Normal length of the gap in between chemo cycles?
A
3-4 weeks
23
Q
What is the difference between primary resistance and acquired resistance to chemo?
A
Primary - where the initial malignant clone is resistant
Secondary - the tumour mutates to become malignant
24
Q
How can high dose chemotherapy be defined?
A
Chemo requiring bone marrow support
25
How many days after the start if a cycle of chemo does the patient get leukopenia and thrombocytopenia?
10-14 days
26
What is the nadir?
The lowest point in thrombocytopenia/ leukopenia
27
At what levels of neutrophils does the risk of infection become significant?
Less than 0.5x10^9/1
28
How longs does haemolytic recovery take?
3-4 weeks
29
What chemo drugs are associated with peripheral neuropathy?
Platinum drugs
30
What are the most carcinogenic chemo drugs?
Alkylating agents
| Procarbazine
31
What are the clinical signs of thrombocytopenia?
Petechial haemorrhage
Spontaneous nose bleeds
Corneal haemorrhage
Haematuria
32
At what levels of platelet counts require regular transfusions?
Anything below 20 x10^9/L
33
What platelet count requires emergency transfusion?
| What are the complications of this?
Less than 10 x 10^9/L
Risk of intracranial haemorrhage and bleeding
34
Neutropenia is a medical emergency, what is the immediate management of neutropenia with associated fever?
Broad spectrum antibiotics
35
What would be considered neutropenia?
WCC
36
Before starting ACE inhibitors what is it important to measure?
How often should this be measured?
U&Es
Creatinine
eGFR
Before starting, after each dose increase, and every three months
37
In a patient with LVSD you would like to start ACE inhibitors, in what scenario should you NOT prescribe unless pt has seen a specialist?
If the pt has suspected valve disease
38
Name 2 beta blockers that are licensed for heart failure?
Bisoprolol
| Carvedilol
39
What do you need to monitor when you give aldosterone antagonists?
Potassium
Creatinine
eGFR
40
Name an example of an aldosterone antagonist..
Spironolactone
41
In radiotherapy what is the gross tumour volume?
Te size of the tumour actual tumour demonstrated by CT
42
In radiotherapy what is the clinical target volume?
The area around the GTV where there may be microscopic spread
43
In radiotherapy what is the planning target volume?
The extra space around the CTV where radiation is aimed to account for daily movements in the tumour
44
What is the characteristic of bone pain?
Dull ache over a large area
Or
Tenderness over a bone
45
What exacerbates bone pain?
Weight bearing
| Movement
46
Name three treatment a for bone pain
NSAIDs (dixlofenac 50mg TDS)
Radiotherapy
Bisphosphonates
47
Describe characteristic visceral pain..
Dull deep poorly localised pain
48
What drugs can be given to reduce the oedema in raised ICP headache?
Corticosteroids
49
Name a non-renally excreted opiate
Fentanyl
50
What groups of patients should you reduce the dose of morphine?
Elderly
Renally impaired
Frail patients
51
What is the normal starting dose of MST if they have been on max strength cocodamol?
MST 20mg bd
52
What is the max strength cocodamol?
30 mg codeine
| 500mg paracetamol
53
How much intermediate release should be given for breakthrough pain in a patient on long acting morphine?
1/6 of the total 24hr dose
54
Name 2 stimulant laxatives
Senna
| Dantron
55
Name 3 stool softeners
Lactulose
Sodium docusate
Movicol
56
When shod stimulant laxity was not be used?
If the patient has colic
57
Name an antispasmodic
Hyocine butylbromide
58
In radiotherapy what is the gross tumour volume?
Te size of the tumour actual tumour demonstrated by CT
59
In radiotherapy what is the clinical target volume?
The area around the GTV where there may be microscopic spread
60
In radiotherapy what is the planning target volume?
The extra space around the CTV where radiation is aimed to account for daily movements in the tumour
61
What cancers most commonly cause spinal cord compressions?
Breast
Bronchus
Prostate
62
Where is the most common site of cord compression?
Thoracic region
63
Name 2 IV bisphosphonates?
Pamidronate
| Zoledronic acid
64
What for a HER2 stand for?
Human epithelial growth factor
65
Which drug is used to treat ca that over expresses HER 2?
Tastuzemab
66
What is the ICF model of health a description of?
Bio-psycho-social functioning
67
What is the ICF description of participation?
Involvement in life situation
that represents societal perception of functioning
and role of person in society
68
What is at the centre of the ICF model of health?
Activity
69
How does the ICF define activity?
Execution of a task or activity represents individual perception of functioning
70
What 3 drugs are started after a stroke?
BP control drugs
Aspirin (for 2 weeks)
Clopidogrel for life
Statin
71
How soon after a stroke should a statin be started?
48h
72
What are included in haematinic blood tests?
Ferritin
Vit B12
folate
73
If someone has low vit B12 and folate how can you treat them?
Give vit b12 injections and folic acid tablets
74
What are the proper names of statins?
HMG-CoA reductase inhibitors
75
What is the mechanism of acton of statins?
Block HMG-CoA reductase, which has a role in producing cholesterol in the liver
76
What common antibiotics do statins react with?
Erythromycin (macrolides)
77
What is first and second line in generalised tonic clinic seizures?
Sodium valproate
Lamotrogine
78
What is first line in absence seizures?
Ethosuximide
Lamotrogine
79
What is the first line in focal seizures?
Lamotrogine or carbamazepine
80
What is the most teratogenic anti epileptic drug?
Sodium valproate
81
In epilepsy what more common drug is a liver enzyme inducer?
Carbamazepine
82
What contraceptive CANT you take with carbamazepine?
POP
| Progesterone implants
83
What happens with contraceptives and Lamotrogine?
Oestrogen based contraceptives can reduce the amount of Lamotrogine so they are more likely to have seizures
84
What supplement is it important to start in women on anti epileptics who want to get pregnant?
Folic acid 5mg
85
In which people can you NOT use for hba1c to diagnose diabetes?
Pregancy (fetal Hb gets in the way)
Haemaglobinopathies
Steroids/antipsychotics
86
Does a value below 48 for hba1c exclude diabetes?
No if it can be shown using glucose measurements
87
How quickly after having a seizure should someone be referred to a specialist?
2 weeks referral
88
What is the difference between clonic and myoclonic seizures?
Clonic - jerking with impaired consciousness
| Myoclonic - shock like contractions of the limb where consciousness is not impaired
89
What is dysphasia?
Inability to interpret or formulate language
90
What three questions do you ask at the start of a SALT assessment?
Eyesight problems
Can you hear me?
English is first language
91
What are the three main areas that are then assess for a language assessment?
Comprehension
Expression
Repetition
92
It terms of testing comprehension how can you do this written or verbally?
One/two stage command
Written command "close your eyes"
93
How do you assess language expression verbally and written?
Name objects
Describe your morning
Write a sentence about the weather
94
How can you assess repetition?
Repeat "today is Friday"
Read a passage
95
What is dysarthria?
Impaired articulation of speech
96
Name a phrase that can be used in a speech assessment
British constitution
West register street
Biblical criticism
97
Describe the global distribution of MS..
More prevalent the more north or south of the equator you go
98
How common is MS?
1:1000
99
What is optic neuritis?
Acute, sometimes painful loss of vision in one eye
100
How do you treat fatigue in MS rehab?
```
Ensure good sleep hygiene
Rule out hypothyroid, infection
Evaluate sedative medication
Energy conservation measures
Work simplification
Adaptive equipment
```
101
Can radiotherapy be used for colorectal cancer?
Yes but only for rectal, with colon it is too near other important organs
102
What type of lung cancer would you consider prophylactic cranial irradiation?
Small cell as brain meta are common
103
What are the side effects of prophylactic cranial irradiation
Memory impairment
Functional deficit
Dementia
104
From which cells in the lung do small cell tumour originate from?
Neuro endocrine
105
What type of tumour are 95% of prostate cancers?
Adenocarcinomas
106
Where in the prostate are adenocarcinomas most common?
Posterior or peripheral prostate tissue
107
Where does BPH arise from in the prostate?
The centre of the gland
108
In the TNM staging what does TX mean?
Primary tumour cannot be assessed
109
In TNM staging what does T0 mean?
No evidence of primary tumour
110
What stage of prostate cancer extends through the prostate capsule?
T3
111
What system is used to grade prostate cancer ?
Gleason system
112
What drugs do you start for stable angina?
GTN spray
Atenolol or amilodipine
Aspirin
Consider
Statins
Hypertensive tx
Ace I if diabetic
113
Name two revascularisation techniques used in stable angina..
CABG or PCI
114
When should a patient with stable angina use their GTN spray?
Before planned exercise
| With chest pain
115
What are the side effects of GTN spray?
Flushing
Headache
Lightheadedness
116
In stable angina if the pain doesn't go away after the first dose what do you do?
Repeat dose 5 mins after the first
Wait a further 5 mins and then call an ambulance
117
After starting long term angina drugs when should the patient be reviewed?
2-4 weeks after starting tx
118
What drugs do you start after an MI?
Ace I
Aspirin
Beta blocker
Statin
119
For patients who have had an MI but also have heart failure what drug should you add?
Spironolactone - aldosterone antagonist
120
If dual antiplatelet therapy has not been started acutely post MI then should you start it?
No need to routinely start this
121
What is the dual platelet therapy post STEMI and post NSTEMI
Post STEMI
aspirin for life
Clopidogrel for 12mo
Post NSTEMI
Aspirin for life
Clopidogrel for 4 weeks
122
What do you need to monitor before and after starting ACE inhibitor?
BP
Renal function
U&Es
123
What do you need to measure with spironolactone?
Renal function
| Potassium levels
124
What are the tumour markers for testicular cancer?
Beta hcg
AFP - in non-semi
LDH
125
When would you biopsy the other testicle in testicular ca?
If there is a Hx of cryptorchidism or maldescent
126
Would you biopsy the first testicle in testicular ca?
No because there is a risk of spreading the ca
127
What is the most common symptom of testicular ca?
Painless testicular swelling
128
What is the most common type of testicular ca?
Germ cell tumour
129
What are the types of germ cell tumours?
Seminoma
Non-seminomatous
130
What are normal calcium levels?
2.25-2.5
131
What is calcium bound to in the blood?
Albumin
132
What is the acute treatment for hypercalcaemia?
IV saline
| Bisphosphonates (pamidronate/ zolendronic acid)
133
How long does calcium levels go back to normal on bisphonates?
5 days
134
What cancers are hypercalcaemia most common?
Myeloma
Breast cancer
Non-small cell lung cancer
135
What are the symptoms of hypercalcaemia?
Drowsiness/ confusion
Nausea vomiting
Constipation
Polyuria/ polydipsia
136
In cancer of unknown primary, you fined mets in brain
| Where could they have come from?
Lung breast melanoma
137
In cancer of unknown primary, you fined mets in lung
| Where could they have come from?
Breast and kidney
138
In cancer of unknown primary, you fined mets in liver
| Where could they have come from?
Lung breast colon
139
In cancer of unknown primary, you fined mets in supra clavicular lymph
Where could they have come from?
Head neck lung breast GI
140
```
A young man with mets in
Para aortic
Mediastinum
Neck nodes
Brain
```
Think germ cell tumour as all of these are midline
141
Woman with auxillary nodes
| When might cancer be?
Breast
142
What is abdominal carciomatosis?
Multiple carcinomas develop at once after dissemination from a primary source
143
A woman with abdo carcinomatosis, where is the likely source?
Ovaries
144
Some one with multiple lymph nodes, likely cause?
Lymphoma
145
In cancer of unknown primary, you fined mets in brain
| Where could they have come from?
Lung breast melanoma
146
In cancer of unknown primary, you fined mets in lung
| Where could they have come from?
Breast and kidney
147
In cancer of unknown primary, you fined mets in liver
| Where could they have come from?
Lung breast colon
148
In cancer of unknown primary, you fined mets in supra clavicular lymph
Where could they have come from?
Head neck lung breast GI
149
```
A young man with mets in
Para aortic
Mediastinum
Neck nodes
Brain
```
Think germ cell tumour as all of these are midline
150
Woman with auxillary nodes
| When might cancer be?
Breast
151
What is abdominal carciomatosis?
Multiple carcinomas develop at once after dissemination from a primary source
152
A woman with abdo carcinomatosis, where is the likely source?
Ovaries
153
Some one with multiple lymph nodes, likely cause?
Lymphoma
CCC
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