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CCC > Chloe's > Flashcards

Chloe's Flashcards

1
Q

Name some sulphonureas..

A

Gliclazide
Glimepiride
Glibenclamide
Tolbutamide

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2
Q

Name some DPP4 inhibitors..

A

Alogliptin, linagliptin, saxagliptin, sitagliptin

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3
Q

What is an impaired fasting glucose?

A

After fasting glucose is between 6.1 and 7 mmol

If above 7 ?diabetes

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4
Q

What is impaired glucose tolerance?

A

2 hour value between 7.8 and 11.1

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5
Q

How often should HBA1C levels be measured in type 2 diabetes?

A

Every 2-6 months until stable

Then every 6 months

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6
Q

What are reed sternburg cells characteristic of?

A

Hodgekins lymphoma

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7
Q

What is the most common type of Hodgkin’s lymphoma?

A

Nodular sclerosing

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8
Q

What deciles is Hodgkin’s most common in?

A

3rd

7th

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9
Q

What type of Hodgkin’s is associated with lacunar cells?

A

Nodular sclerosing

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10
Q

What are the B symptoms in Hodgkin’s?

A

Weight loss over 10% in 6 months
Fever above 38
Night sweats

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11
Q

What 3 things on an X-ray suggest COPD?

A

Hyperinflation

Flattened hemidiaphragms
Hyperlucent lung fields

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12
Q

What is neoadjuvent chemotherapy?

A

Used to reduce tumour size before planned surgical intervention

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13
Q

What is primary chemotherapy?

A

Where it is in operable but the chemo may lead to possible surgery

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14
Q

What is adjuvent chemotherapy?

A

Chemo after surgery to treat occult microscopic metastasis

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15
Q

Give and example of prophylactic chemotherapy?

A

Tamoxifen for insitu breast ca before invasive carcinoma is seen

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16
Q

How are chemotherapy doses calculated?

A

Using body surface area

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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

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18
Q

What cancers is chemo really good in? (Over 50% cure)

A

Hodgkin’s
Testicular ca
ALL
Paeds ca (leukaemia, lymphoma, sarcoma)

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19
Q

When might single dose chemo be appropriate?

A

In palliative care as it is rarely curative

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20
Q

What are the main aims of combination chemotherapies?

A

Maximise cell kill
Minimise toxicity in non -tumours cells
Minimise development of resistance

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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

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22
Q

Normal length of the gap in between chemo cycles?

A

3-4 weeks

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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

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24
Q

How can high dose chemotherapy be defined?

A

Chemo requiring bone marrow support

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25
Q

How many days after the start if a cycle of chemo does the patient get leukopenia and thrombocytopenia?

A

10-14 days

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26
Q

What is the nadir?

A

The lowest point in thrombocytopenia/ leukopenia

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27
Q

At what levels of neutrophils does the risk of infection become significant?

A

Less than 0.5x10^9/1

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28
Q

How longs does haemolytic recovery take?

A

3-4 weeks

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29
Q

What chemo drugs are associated with peripheral neuropathy?

A

Platinum drugs

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30
Q

What are the most carcinogenic chemo drugs?

A

Alkylating agents

Procarbazine

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31
Q

What are the clinical signs of thrombocytopenia?

A

Petechial haemorrhage
Spontaneous nose bleeds
Corneal haemorrhage
Haematuria

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32
Q

At what levels of platelet counts require regular transfusions?

A

Anything below 20 x10^9/L

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33
Q

What platelet count requires emergency transfusion?

What are the complications of this?

A

Less than 10 x 10^9/L

Risk of intracranial haemorrhage and bleeding

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34
Q

Neutropenia is a medical emergency, what is the immediate management of neutropenia with associated fever?

A

Broad spectrum antibiotics

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35
Q

What would be considered neutropenia?

A

WCC

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36
Q

Before starting ACE inhibitors what is it important to measure?

How often should this be measured?

A

U&Es
Creatinine
eGFR

Before starting, after each dose increase, and every three months

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37
Q

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?

A

If the pt has suspected valve disease

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38
Q

Name 2 beta blockers that are licensed for heart failure?

A

Bisoprolol

Carvedilol

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39
Q

What do you need to monitor when you give aldosterone antagonists?

A

Potassium
Creatinine
eGFR

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40
Q

Name an example of an aldosterone antagonist..

A

Spironolactone

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41
Q

In radiotherapy what is the gross tumour volume?

A

Te size of the tumour actual tumour demonstrated by CT

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42
Q

In radiotherapy what is the clinical target volume?

A

The area around the GTV where there may be microscopic spread

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43
Q

In radiotherapy what is the planning target volume?

A

The extra space around the CTV where radiation is aimed to account for daily movements in the tumour

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44
Q

What is the characteristic of bone pain?

A

Dull ache over a large area
Or
Tenderness over a bone

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45
Q

What exacerbates bone pain?

A

Weight bearing

Movement

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46
Q

Name three treatment a for bone pain

A

NSAIDs (dixlofenac 50mg TDS)
Radiotherapy
Bisphosphonates

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47
Q

Describe characteristic visceral pain..

A

Dull deep poorly localised pain

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48
Q

What drugs can be given to reduce the oedema in raised ICP headache?

A

Corticosteroids

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49
Q

Name a non-renally excreted opiate

A

Fentanyl

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50
Q

What groups of patients should you reduce the dose of morphine?

A

Elderly
Renally impaired
Frail patients

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51
Q

What is the normal starting dose of MST if they have been on max strength cocodamol?

A

MST 20mg bd

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52
Q

What is the max strength cocodamol?

A

30 mg codeine

500mg paracetamol

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53
Q

How much intermediate release should be given for breakthrough pain in a patient on long acting morphine?

A

1/6 of the total 24hr dose

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54
Q

Name 2 stimulant laxatives

A

Senna

Dantron

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55
Q

Name 3 stool softeners

A

Lactulose
Sodium docusate
Movicol

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56
Q

When shod stimulant laxity was not be used?

A

If the patient has colic

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57
Q

Name an antispasmodic

A

Hyocine butylbromide

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58
Q

In radiotherapy what is the gross tumour volume?

A

Te size of the tumour actual tumour demonstrated by CT

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59
Q

In radiotherapy what is the clinical target volume?

A

The area around the GTV where there may be microscopic spread

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60
Q

In radiotherapy what is the planning target volume?

A

The extra space around the CTV where radiation is aimed to account for daily movements in the tumour

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61
Q

What cancers most commonly cause spinal cord compressions?

A

Breast
Bronchus
Prostate

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62
Q

Where is the most common site of cord compression?

A

Thoracic region

63
Q

Name 2 IV bisphosphonates?

A

Pamidronate

Zoledronic acid

64
Q

What for a HER2 stand for?

A

Human epithelial growth factor

65
Q

Which drug is used to treat ca that over expresses HER 2?

A

Tastuzemab

66
Q

What is the ICF model of health a description of?

A

Bio-psycho-social functioning

67
Q

What is the ICF description of participation?

A

Involvement in life situation
that represents societal perception of functioning
and role of person in society

68
Q

What is at the centre of the ICF model of health?

A

Activity

69
Q

How does the ICF define activity?

A

Execution of a task or activity represents individual perception of functioning

70
Q

What 3 drugs are started after a stroke?

A

BP control drugs
Aspirin (for 2 weeks)
Clopidogrel for life
Statin

71
Q

How soon after a stroke should a statin be started?

A

48h

72
Q

What are included in haematinic blood tests?

A

Ferritin
Vit B12
folate

73
Q

If someone has low vit B12 and folate how can you treat them?

A

Give vit b12 injections and folic acid tablets

74
Q

What are the proper names of statins?

A

HMG-CoA reductase inhibitors

75
Q

What is the mechanism of acton of statins?

A

Block HMG-CoA reductase, which has a role in producing cholesterol in the liver

76
Q

What common antibiotics do statins react with?

A

Erythromycin (macrolides)

77
Q

What is first and second line in generalised tonic clinic seizures?

A

Sodium valproate

Lamotrogine

78
Q

What is first line in absence seizures?

A

Ethosuximide

Lamotrogine

79
Q

What is the first line in focal seizures?

A

Lamotrogine or carbamazepine

80
Q

What is the most teratogenic anti epileptic drug?

A

Sodium valproate

81
Q

In epilepsy what more common drug is a liver enzyme inducer?

A

Carbamazepine

82
Q

What contraceptive CANT you take with carbamazepine?

A

POP

Progesterone implants

83
Q

What happens with contraceptives and Lamotrogine?

A

Oestrogen based contraceptives can reduce the amount of Lamotrogine so they are more likely to have seizures

84
Q

What supplement is it important to start in women on anti epileptics who want to get pregnant?

A

Folic acid 5mg

85
Q

In which people can you NOT use for hba1c to diagnose diabetes?

A

Pregancy (fetal Hb gets in the way)
Haemaglobinopathies
Steroids/antipsychotics

86
Q

Does a value below 48 for hba1c exclude diabetes?

A

No if it can be shown using glucose measurements

87
Q

How quickly after having a seizure should someone be referred to a specialist?

A

2 weeks referral

88
Q

What is the difference between clonic and myoclonic seizures?

A

Clonic - jerking with impaired consciousness

Myoclonic - shock like contractions of the limb where consciousness is not impaired

89
Q

What is dysphasia?

A

Inability to interpret or formulate language

90
Q

What three questions do you ask at the start of a SALT assessment?

A

Eyesight problems
Can you hear me?
English is first language

91
Q

What are the three main areas that are then assess for a language assessment?

A

Comprehension
Expression
Repetition

92
Q

It terms of testing comprehension how can you do this written or verbally?

A

One/two stage command

Written command “close your eyes”

93
Q

How do you assess language expression verbally and written?

A

Name objects
Describe your morning

Write a sentence about the weather

94
Q

How can you assess repetition?

A

Repeat “today is Friday”

Read a passage

95
Q

What is dysarthria?

A

Impaired articulation of speech

96
Q

Name a phrase that can be used in a speech assessment

A

British constitution
West register street
Biblical criticism

97
Q

Describe the global distribution of MS..

A

More prevalent the more north or south of the equator you go

98
Q

How common is MS?

A

1:1000

99
Q

What is optic neuritis?

A

Acute, sometimes painful loss of vision in one eye

100
Q

How do you treat fatigue in MS rehab?

A 
Ensure good sleep hygiene 
Rule out hypothyroid, infection 
Evaluate sedative medication 
Energy conservation measures 
Work simplification 
Adaptive equipment
101
Q

Can radiotherapy be used for colorectal cancer?

A

Yes but only for rectal, with colon it is too near other important organs

102
Q

What type of lung cancer would you consider prophylactic cranial irradiation?

A

Small cell as brain meta are common

103
Q

What are the side effects of prophylactic cranial irradiation

A

Memory impairment
Functional deficit
Dementia

104
Q

From which cells in the lung do small cell tumour originate from?

A

Neuro endocrine

105
Q

What type of tumour are 95% of prostate cancers?

A

Adenocarcinomas

106
Q

Where in the prostate are adenocarcinomas most common?

A

Posterior or peripheral prostate tissue

107
Q

Where does BPH arise from in the prostate?

A

The centre of the gland

108
Q

In the TNM staging what does TX mean?

A

Primary tumour cannot be assessed

109
Q

In TNM staging what does T0 mean?

A

No evidence of primary tumour

110
Q

What stage of prostate cancer extends through the prostate capsule?

A

T3

111
Q

What system is used to grade prostate cancer ?

A

Gleason system

112
Q

What drugs do you start for stable angina?

A

GTN spray
Atenolol or amilodipine
Aspirin

Consider
Statins
Hypertensive tx
Ace I if diabetic

113
Q

Name two revascularisation techniques used in stable angina..

A

CABG or PCI

114
Q

When should a patient with stable angina use their GTN spray?

A

Before planned exercise

With chest pain

115
Q

What are the side effects of GTN spray?

A

Flushing
Headache
Lightheadedness

116
Q

In stable angina if the pain doesn’t go away after the first dose what do you do?

A

Repeat dose 5 mins after the first

Wait a further 5 mins and then call an ambulance

117
Q

After starting long term angina drugs when should the patient be reviewed?

A

2-4 weeks after starting tx

118
Q

What drugs do you start after an MI?

A

Ace I
Aspirin
Beta blocker
Statin

119
Q

For patients who have had an MI but also have heart failure what drug should you add?

A

Spironolactone - aldosterone antagonist

120
Q

If dual antiplatelet therapy has not been started acutely post MI then should you start it?

A

No need to routinely start this

121
Q

What is the dual platelet therapy post STEMI and post NSTEMI

A

Post STEMI
aspirin for life
Clopidogrel for 12mo

Post NSTEMI
Aspirin for life
Clopidogrel for 4 weeks

122
Q

What do you need to monitor before and after starting ACE inhibitor?

A

BP
Renal function
U&Es

123
Q

What do you need to measure with spironolactone?

A

Renal function

Potassium levels

124
Q

What are the tumour markers for testicular cancer?

A

Beta hcg
AFP - in non-semi
LDH

125
Q

When would you biopsy the other testicle in testicular ca?

A

If there is a Hx of cryptorchidism or maldescent

126
Q

Would you biopsy the first testicle in testicular ca?

A

No because there is a risk of spreading the ca

127
Q

What is the most common symptom of testicular ca?

A

Painless testicular swelling

128
Q

What is the most common type of testicular ca?

A

Germ cell tumour

129
Q

What are the types of germ cell tumours?

A

Seminoma

Non-seminomatous

130
Q

What are normal calcium levels?

A

2.25-2.5

131
Q

What is calcium bound to in the blood?

A

Albumin

132
Q

What is the acute treatment for hypercalcaemia?

A

IV saline

Bisphosphonates (pamidronate/ zolendronic acid)

133
Q

How long does calcium levels go back to normal on bisphonates?

A

5 days

134
Q

What cancers are hypercalcaemia most common?

A

Myeloma
Breast cancer
Non-small cell lung cancer

135
Q

What are the symptoms of hypercalcaemia?

A

Drowsiness/ confusion
Nausea vomiting
Constipation
Polyuria/ polydipsia

136
Q

In cancer of unknown primary, you fined mets in brain

Where could they have come from?

A

Lung breast melanoma

137
Q

In cancer of unknown primary, you fined mets in lung

Where could they have come from?

A

Breast and kidney

138
Q

In cancer of unknown primary, you fined mets in liver

Where could they have come from?

A

Lung breast colon

139
Q

In cancer of unknown primary, you fined mets in supra clavicular lymph
Where could they have come from?

A

Head neck lung breast GI

140
Q 
A young man with mets in 
Para aortic
Mediastinum
Neck nodes
Brain
A

Think germ cell tumour as all of these are midline

141
Q

Woman with auxillary nodes

When might cancer be?

A

Breast

142
Q

What is abdominal carciomatosis?

A

Multiple carcinomas develop at once after dissemination from a primary source

143
Q

A woman with abdo carcinomatosis, where is the likely source?

A

Ovaries

144
Q

Some one with multiple lymph nodes, likely cause?

A

Lymphoma

145
Q

In cancer of unknown primary, you fined mets in brain

Where could they have come from?

A

Lung breast melanoma

146
Q

In cancer of unknown primary, you fined mets in lung

Where could they have come from?

A

Breast and kidney

147
Q

In cancer of unknown primary, you fined mets in liver

Where could they have come from?

A

Lung breast colon

148
Q

In cancer of unknown primary, you fined mets in supra clavicular lymph
Where could they have come from?

A

Head neck lung breast GI

149
Q 
A young man with mets in 
Para aortic
Mediastinum
Neck nodes
Brain
A

Think germ cell tumour as all of these are midline

150
Q

Woman with auxillary nodes

When might cancer be?

A

Breast

151
Q

What is abdominal carciomatosis?

A

Multiple carcinomas develop at once after dissemination from a primary source

152
Q

A woman with abdo carcinomatosis, where is the likely source?

A

Ovaries

153
Q

Some one with multiple lymph nodes, likely cause?

A

Lymphoma

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