25 September 2023.
56 |
Teresa Kelly. COVID |
57 |
Structured conversation. Waiting list prioritisation |
SBA. Quinolone antibiotics |
|
59 |
SBA. Yellow card
reporting system |
Teresa is
a Consultant at St. Mary’s hospital, the main teaching hospital in Manchester.
She ran the COVID service from the desperate earliest days when little was
known about how best to manage the disease. She gives an insight into the
difficulties and how knowledge and management improved rapidly, particularly in
relation to treatment and vaccines. She also displays her great commitment to
individual patients; almost a ‘my girls’ attachment.
Her
Scottish accent is even more pronounced than mine and, like most Glaswegians,
she speaks very quickly, so you will need to listen carefully, but I hope your
ears will soon tune in.
57. Structured
conversation. Waiting list prioritisation.
Your consultant is away. The waiting-list manager comes to see you. The
following patients have been listed by junior staff. The waiting-list manager
wants you to:
confirm the appropriateness of the proposed treatment,
decide the degree of urgency,
confirm the appropriateness of the proposed venue,
decide any special requirement(s) for each patient.
Name |
Age |
Clinical Problem |
Proposed operation |
Venue |
Special Needs |
Urgency |
JK |
5 |
chronic discharge. ? foreign body |
EUA |
Main theatre |
|
|
JM |
32 |
1ry. infertility |
Laparoscopy + tubal patency tests |
Main theatre |
|
|
GN |
77 |
Vulval cancer. Coronary thrombosis x 2.
Unstable angina. |
Radical vulvectomy agreed at |
Main theatre |
|
|
RU |
55 |
PMB x1. Weight 20 stones. (127 kg.) 1 kg. = 2.2 lb. 1 stone = 14 lb. |
D&C. |
|
|
|
LD |
32 |
Menorrhagia. Fibroids. Anaemia. |
Vaginal hysterectomy. |
Main theatre. |
|
|
DT |
22 |
Does not want children. |
Lap. Steril. |
|
|
|
HB |
14 |
Unwanted pregnancy at 10/52. |
TOP |
|
. |
|
JY |
44 |
GSI. |
Anterior colporrhaphy. |
Main theatre. |
|
|
JS |
23 |
Vaginal discharge. Cervical ectropion. |
Diathermy to cervix. |
|
|
|
DT |
55 |
3 cm. ovarian mass. |
Laparoscopy ? proceed to Hyst +
BSO. |
Main theatre. |
|
|
EV |
32 |
|
Cone biopsy. |
|
|
|
UW |
34 |
Endometriosis |
Laparoscopic ablation |
|
|
|
HT |
88 |
Cystocoele/ rectocoele/ 2nd. degree
uterine prolapse |
Manchester Repair. |
Main theatre. |
|
|
KN |
58 |
Haematuria |
Cystoscopy |
|
|
|
JW |
18 |
Menorrhagia & copes badly with menstrual
hygiene. Has Down’s syndrome. Sexually active. |
Hysterectomy |
Main theatre |
|
|
TB |
30 |
Menorrhagia. 2nd. degree uterine
descent. Been sterilised. Jehovah’s witness. |
Vaginal hysterectomy and repair. |
Main theatre. |
|
|
BM |
55 |
Stage Ib cancer cervix. Been discussed at MDT.
For Wertheim’s hysterectomy. Factor V Leiden. VTE on Pill. On warfarin. |
Wertheim’s hysterectomy. |
Main theatre. |
|
|
NU |
60 |
Recurrent rectocoele. |
Posterior colporrhaphy. |
Main theatre. |
|
|
58. SBA. Quinolone & fluoroquinolone antibiotics.
Abbreviations.
FQ: fluoroquinolone.
SLE: systemic lupus
erythematosus.
QUI: quinolone.
Question 1. Which, if any, of the following drugs are QUIs or
FQs?
Drugs
A |
cimetidine |
B |
ciprofloxacin |
C |
nalidixic
acid |
D |
neomycin |
E |
nitrofurantoin |
Option List
1 |
A + B |
2 |
A +
B + C |
3 |
B +
C |
4 |
B +
C + D + E |
5 |
A +
B + C + D + E |
Question 2. Which, if any, of the following statements are true in
relation to QUIs & FQs? This is
not a true SBA as there may be more than one answer.
Statements
A |
nalidixic acid is an older quinolone and is mainly excreted in the
urine |
B |
ciprofloxacin
is effective against most Gram +ve and –ve bacteria and 1st- line
treatment for pneumococcal pneumonia. |
C |
ciprofloxacin
is contraindicated in pregnancy due to the ↑ risk of neonatal haemolysis |
D |
many
staphylococci are resistant to quinolones |
E |
quinolones
are particularly useful in the treatment of MRSA |
Question 3. Which was the first QUI antibiotic?
Option List
A |
acetylsalicylic acid |
B |
nalidixic acid |
C |
oxalic acid |
D |
pipemidic acid |
E |
none of the above |
Question 4. How do QUI and FQ antibiotics work? There is only one
correct answer.
Option
List
A |
impair bacterial DNA coiling |
B |
impair bacterial DNA binding |
C |
impair bacterial RNA action |
D |
impair bacterial mitochondrial action |
E |
none of the above. |
Question 5. Which, if any, of the following QUIs & FQs is not
available for prescription in the UK.
There is only one correct answer.
Option
List
A |
ciprofloxacin |
B |
levofloxacin |
C |
nalidixic acid |
D |
moxifloxacin |
E |
ofloxacin |
Question 6. Which, if any, of the following statements are true in
relation to the quinolones and
fluoroquinolones and pregnancy? This is not a true SBA as there may be
more than one answer.
Option list.
A |
FQs are newer than QUIs with better systemic spread and efficacy |
B |
QUIs
concentrate in urine but have a special affinity for cartilage |
C |
consumption
of a FQ in the 1st. trimester is grounds for TOP |
D |
if
an FQ is used, norfloxacin and ciprofloxacin should be considered 1st. |
E |
FQs
are linked to a risk of discolouration of the teeth of offspring |
Question 7. Which of the following is true about the warning
issued by the FDA in 2008 in relation
to QUIs & FQs?
Option List
A |
they may cause congenital cartilage defects |
B |
they may cause congenital deafness |
C |
they may cause tendonitis and tendon rupture |
D |
they may cause prolongation of the Q-T interval |
E |
none of the above |
Question 8. Which of the following is true about the warning
issued by the FDA in 2011 in relation
to QUIs & FQs?
Option List
A |
they may cause exacerbation of eczema |
B |
they may cause exacerbation of hypertension |
C |
they may cause exacerbation of multiple sclerosis |
D |
they may cause exacerbation of myasthenia gravis |
E |
they may cause exacerbation of SLE |
Question 9. Which of the following is true about the warning
emphasised by the FDA in 2013 in
relation to QUIs & FQs?
Option List
A |
they may cause aortic dissection |
B |
they may cause mitral stenosis |
C |
they may cause pancreatitis |
D |
they may cause peripheral neuropathy |
E |
they may cause flare of SLE |
Question 10. FDA issued a warning in July 2016. Which, if any, of
the following were included? This
is not a true SBA as there may be more than one answer.
Option List
A |
the risks generally outweigh the benefits |
B |
QUIs & FQs should not be used for acute sinusitis, |
C |
QUIs & FQs should not be used for exacerbation of chronic bronchitis |
D |
QUIs & FQs should not be used for uncomplicated UTI |
E |
QUIs & FQs may be useful for anthrax and plague |
Question 11. FDA issued a warning in July 2018 about the use of FQs
in pregnancy. Which, if any, of
the following were included in the reasons for its publication?
Option List
A |
to strengthen previous warnings about hyperglycaemia and mental health
risks |
B |
to strengthen previous warnings about hypoglycaemia and mental health
risks |
C |
to strengthen previous warnings about the risk of ASD in the offspring |
D |
to strengthen previous warnings about the risk of acute pancreatitis |
E |
to strengthen previous warnings about the risk of PET |
Question 12. The FDA issued a warning in December 2018 about the
use of FQs in pregnancy.
Which, if any, of the following was included? This is an SBA with only
one correct answer.
Option
List
A |
↑ risk of
atrial fibrillation |
B |
↑ risk of
aortic aneurysm and rupture |
C |
↑ risk of
mitral stenosis |
D |
↑ risk of
pulmonary hypertension |
E |
↑ risk of
ulcerative colitis |
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