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Interactive past paper - SAHD 2006

Score +1 for a correct answer, -1 for an incorrect answer, 0 for 'don't know'.

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1. Concerning drug treatment of inflammatory bowel disease, the following statements are true:

a) Oral steroids are commonly used to treat quiescent disease.


b) Adrenal suppression is a recognized adverse effect of long term steroid therapy in patients with inflammatory bowel disease.

c) Abrupt withdrawal of steroid therapy should be avoided only in patients receiving steroids by the parenteral route.

d) Topical rectal steroids are the drug of choice in patients with increased stool frequency.

e) Adequate small intestinal absorption of 5 aminosalicylates is essential for their drug effect.

f) Impaired renal function is a recognized adverse effect of treatment with 5-aminosalicylates.

g) Osteoporosis in IBD is partly due to steroid therapy.

h) Azathioprine is a recognized immuno-suppressive agent for treatment of inflammatory bowel disease.

i) If possible methotrexate should be avoided in women of childbearing age

j) Male hypospermia due to sulphasalazine is irreversible.

2. i. Concerning the treatment of constipation:

Lactulose is an osmotic laxative at recommended doses.


Attempts at dietary modification should precede drug treatment.

Plant glycosides like senna are pro-drugs and are activated by colonic bacteria.

Hypokalaemia is a complication of long-term laxative abuse.

Melanosis coli occurs in patients using plant glycosides.

2 ii. It is essential to monitor drug plasma levels during treatment with the following medications:

Gentamicin


Tetracycline

Lithium

Penicillin

Salbutamol

3. In effective treatment of non-ST elevation myocardial infarction with on-going chest pain:

Thrombolytics should always be administered.


Low molecular weight heparins are indicated.

Clopidogrel should never be combined with aspirin.

Clopidogrel is licensed to be given for up to one year for secondary prevention.

Intravenous glycoprotein IIb/IIIa receptor antagonists are clinically helpful.

Thrombocytopenia and bleeding may be caused by GP IIb/IIIa receptor antagonists.

Intravenous nitroglycerin may be prescribed for chest pain.

Calcium-channel blockers should never be prescribed.

ACE inhibitors have no role.

Statins are contra-indicated.

3. The following statements are true:

Nitrates are contra-indicated in the acute management of heart attack.


Treatment with digoxin has been shown to reduce the severity of severe heart failure in patients in sinus rhythm.

Constipation is a recognised adverse effect of the calcium channel blocker verapamil.

Seizures are a recognised complication of treatment with lidocaine.

Lidocaine is contraindicated in the acute treatment of serious ventricular arrhythmias.

Reperfusion arrhythmias are a recognised serious adverse effect of treatment with tissue plasminogen activator.

Spironolactone is recognised to reduce morbidity in patients with heart failure.

Hypokalaemia is a recognised adverse effect of angiotension converter enzyme inhibition.

Bisoprolol is a first line drug of choice for treating heart failure.

Altered thyroid function is a recognised adverse effect of amiodarone treatment.

5. i. Beta blockers can precipitate congestive cardiac failure when given with the following drugs:

Omeprazole


Diltiazem

Atorvastatin

Verapamil

Paracetamol

5. ii. In the effective treatment of chronic left heart failure:

An ACE inhibitor is first line therapy.


Angiotensin-receptor blockers such as valsartan are contra-indicated.

Spironolactone may cause gynaecomastia.

A combination of hydralazine and an oral nitrate may be given if an angiotensin converting enzyme inhibitor cannot be prescribed because of renal dysfunction.

The commonest cause of hyponatraemia is a beta-blocker.

6. The following statements are true.

Oral administration is the route of choice for loop diuretic treatment of severe right heart failure.


Frusemide 400 mg od is a common starting dose for the treatment of heart failure.

Bendroflumethazide and bumetanide is an effective combination for treating oedema in patients with severe heart failure.

Aspirin 75-150 mg od is a typical treatment for the secondary prevention of ischaemic stroke.

Angio-oedema is a recognised serious adverse effect of ACE inhibitor treatment.

Alpha-methyldopa is licensed for the treatment of hypertension in pregnancy.

Tachycardia is a common adverse response to diltiazem treatment.

British Hypertension Society Guidelines suggest that the combination of an ACE inhibitor with a beta blocker is a combination of choice for treating high blood pressure when a second blood pressure lowering agent is indicated.

An angiotensin receptor blocker is a treatment of choice for hypertension secondary to renal artery stenosis.

Enalapril is a first line treatment of choice for patients with Conn’s Syndrome (primary hyperaldosteronism).

7. i. The following statements are true:

Simvastatin lowers cholesterol by stimulating the enzyme HMG CoA reductase.


Simvastatin 20 mg od is a typical starting dose for treatment of hypercholesterolemia.

Simvastatin is effective in the prevention of recurrent ischaemic heart disease.

Bezafibrate is a treatment of choice for hypertriglyceridaemia.

Raised plasma creatinine is a common adverse effect of statin treatment.

7. ii. The following analgesics are NSAIDs (non-steroidal anti-inflammatory drugs):

Paracetamol


Pizotifen

Tramadol

Ketoprofen

Celecoxib

8. The following statements are true:

Allopurinol protects from gout by inhibiting the enzyme xanthine oxidase.


Treatment with allopurinol is useful in the initial management of acute gout.

Treatment with Ibuprofen may increase the severity of heart failure.

A bisphosphonate (e.g. alendronate) is a treatment of choice for osteomalacia

Ciclosporin is in recognized treatment for osteomalacia resulting from renal failure.

Sulphasalazine is an effective disease modifying treatment for rheumatoid disease.

Nephrotic syndrome is a recognised adverse effect of treatment with gold- containing drugs.

Colchicine is effective in treating acute gout by reducing white cell motility.

Penicillamine has clinically useful anti-inflammatory effects.

Methotrexate is an effective treatment option in juvenile rheumatoid arthritis.

9. i. The anticoagulant effect of warfarin can be reversed by giving:

Vitamin K


Protamine

Vitamin D

Enoxaparin

Fresh frozen plasma

9. ii. The following statements are true:

Ferrous sulphate enhances the bio-availability of oral tetracycline treatment.


Desferioxamine is a recognised treatment for haemachromatosis.

Vitamin B12 treatment completely reverses neurological abnormalities due to B12 deficiency.

Oral vitamin B12 is the treatment of choice for pernicious anaemia

Erythropoietin is effective in reversing low platelet count in patient with idiopathic thrombocytopoenic purpura.

10. The following statements are true:

Montelukast treatment should be avoided in patients with asthma


Salmeterol is effective in the acute management of severe asthma.

Ipratroprium bromide bronchodilates by inhibition of bronchial muscarinic receptors

Aminophylline relaxes airways by inhibiting the enzyme phosphodiesterase G

The bronchodilator response to salbutamol is enhanced by the addition of treatment with aminophylline.

Corticosteroids have an immediate effect to relieve bronchospasm in chronic obstructive lung disease.

Opiates are a treatment of choice to relieve anxiety in patients with acute respiratory failure

Oral candidiasis is a recognized adverse effect of inhaled corticosteroid therapy

Vitamin B1 (thiamine) is a recognized treatment to reduce risk of isoniazid-induced peripheral neuropathy.

Ethambutol should be avoided in patients with severe renal impairment

11. The following statements are true:

Fludrocortisone is useful in the treatment of hypoadrenalism (Addison’s Disease).


Weight gain is a recognised adverse effect of anti-diabetic treatment with gliclazide.

Rosiglitazone improves diabetic control by sensitising cells to insulin.

Metformin is recognized to be effective in improving the response to insulin in the treatment of insulin dependent diabetes mellitus.

Tri-iodothyronine is a treatment of choice for hyperthyroidism.

Carbimazole reduces thyroid overactivity within one week of initiating treatment of hyperthyroidism.

Low white blood count is a recognized serious adverse effect of carbimazole.

Propylthiouracil is a drug of choice for treating hyperthyroidism during pregnancy.

L-Thyroxine supplement should be introduced gradually in the treatment of hypothyroidism in adults.

L-Thyroxine 150μg once daily is a typical maintenance replacement dose for treating hypothyroidism.

12. The following statements about prophylactic antibiotics are true:

Prophylactic antibiotic treatment is contraindicated in patients with bronchiectasis.


In non-resistant areas where falciparum malaria is endemic, chloroqine is recognized as effective antimalarial prophylaxis.

Post-exposure prophylaxis is available following HIV contamination.

Sumatriptan is effective in prophylaxis of migraine.

Fusidic acid prior to dental procedures is a first line prophylactic treatment against endocarditis in patients with valvular heart disease.

Rifampicin is recognized prophylaxis following exposure to a patient with meningococcal septicaemia.

Folic acid supplements have been shown to reduce the incidence of neural tube defects in offspring, when taken around the time of conception and during early pregnancy.

Phenobarbitone is commonly use for seizure prophylaxis in children.

Vitamin supplements are recognized to reduce the risk of a wide range of cancers.

Effectiveness of the combined oral contraceptive pill is reduced by high alcohol intake.

13. The following statements are true:

Dependence on diazepam typically begins after 2 weeks treatment


Cocaine use is recognized to increase risk of myocardial infarction.

Carbidopa is an effective first line monotherapy to reduce Parkinsonian symptoms.

Seligiline is recognized to improve Parkinsonian symptoms by increasing breakdown of dopamine in extra-pyramidal pathways.

Hypertension is a recognized adverse effect of the anti-depressant venlafaxine.

In management of status epilepticus, diltiazem is effective first line treatment.

Sodium valproate reduces the effectiveness of the combined oral contraceptive.

Amitriptyline is a recognized treatment for reducing neuropathic pain.

Chlorpromazine is recognized to have extra-pyramidal side effects.

Nitrous oxide with oxygen is useful treatment for peri-partum analgesia.

14. The following statements are true:

Bendroflumethazide is a potent inhibitor of carbonic anhydrase.


Amiloride is an effective potassium-sparing diuretic.

Azathioprine immunosuppresses by inhibition of the enzyme DNA gyrase.

Ciclosporin treatment is recognised to impair renal function.

Aluminium hydroxide is useful simple treatment to raise phosphate levels in patients with chronic renal failure.

Urinary retention is a common adverse effect of doxazosin treatment.

Liver failure is recognized to increase sensitivity to warfarin treatment

Aspirin use should be avoided in young children because of the risk of hepatic failure

Opiates are recognized to precipitate hepatic encephalopathy in patients with severe liver disease.

Flucloxacillin is a recognized cause of cholestatic jaundice.

15. The following statements are true:

Grapefruit juice is recognized to increase plasma levels of drugs metabolized by liver cytochrome enzymes.


Amitriptyline in overdose commonly causes clinically important bradycardia.

N-acetyl cysteine is clinically helpful in the management of aspirin overdose.

Rifampicin is recognized to reduce the effectiveness of the oral contraceptive pill.

Carbamazepine is recognized to reduce the anti-coagulant effect of warfarin.

Naloxone is an effective long-acting antidote for opiate overdose.

Paracetamol typically causes major liver damage within minutes of overdose.

Flumazenil is an effective benzodiazepine antagonist.

Macrocytic anaemia is a recognized adverse effect of phenytoin treatment.

Low white blood count is an important adverse effect of high dose sulphonamide treatment.
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