QuestionPrescription
QuestionComment
Should be able to give multiple versions of the same answer 
I put 1 week but its marked as wrong
39631
User
subscriber
WBC Zebras
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3584
Helicobacter Pylori management in a penicillin-allergic patient
Topic
92
General Practice
## Drug choice feedback

This gentleman has a gastric ulcer secondary to helicobacter pylori infection. He should therefore be prescribed triple therapy. Classically, triple therapy consists of a proton pump inhibitor, and two antibiotics - clarithromycin and amoxicillin. This patient has a penicillin allergy however so amoxicillin is replaced by metronidazole.

## Dose/Route/Frequency/Duration feedback

400mg BD for 7 days is the optimum dose of metronidazole to treat helicobacter (alongside the rest of the prescribed triple therapy).
10051
PrescriptionAnswer
PrescribeAnswerData
400 mg
PrescribeAnswerData
metronidazole 400 mg tablets
PrescribeAnswerData
7 days
PrescribeAnswerData
twice daily (BD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
400 mg
PrescribeAnswerData
metronidazole 400 mg tablets
PrescribeAnswerData
1 week
PrescribeAnswerData
twice daily (BD)
PrescribeAnswerData
oral (PO)
Case Presentation: A 63-year-old gentleman attends his GP with dyspepsia. He does not report any weight loss, no vomiting, no changes to appetite.


## PH
Obesity, hypercholesterolaemia, hypertension

## DH
Atorvastatin 40mg PO OD, ramipril 5mg PO OD.

He is allergic to penicillin.

## FHx

No upper gastrointestinal cancer

## On examination

He is alert and oriented. Upon palpation of the abdomen, there is epigastric tenderness, there are no other abnormalities.

Temperature 36.9°C, HR 80, RR 16, BP 143/92mmHg O<sub>2</sub> 98% RA, GCS 15, Weight 106kg

## Investigations

FBC: Hb 146, WCC 5.2, Plt 328

2ww OGD performed: "Benign gastric ulceration noted, no oesophagitis, no masses seen."

Stool antigen test for _H. pylori_: positive

## Prescribing Request

It is decided he should be started on triple therapy. He has already had omeprazole and clarithromycin prescribed.

Write a prescription for one drug that is most appropriate to treat his helicobacter pylori infection.