QuestionMultiA
QuestionChoice
50242
c
Sertraline;50mg;PO;OD
QuestionChoice
50240
a
Salbutamol;200mg;INH;PRN
QuestionChoice
50248
i
Fluticasone;100 micrograms;intranasal, one application;OD
QuestionChoice
50245
f
Simvastatin;20mg;PO;OD
QuestionChoice
50247
h
Cetirizine;10mg;PO;OD
QuestionChoice
50244
e
Ramipril;10mg;PO;OD
QuestionChoice
50246
g
Microgynon 30;1 tablet;PO;daily for 21 days with a pill free week following this
QuestionChoice
50241
b
Paracetamol;1g;PO;QDS
QuestionChoice
50243
d
Metformin;500mg;PO;TDS
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
3636
The combined oral contraceptive pill, ramipril and metformin are all medications that need stopping before surgery and dosing error of a salbutamol inhaler
Topic
13
Neurosurgery
1. Ramipril, microgynon 30 and metformin should be held before surgery. COCPs should be held for 4 weeks prior to surgery due to the increased risk of thromboembolism. ACE inhibitors/angiotensin-II receptor antagonists should be omitted the day before surgery due to an increases risk of severe hypotension after induction of anaesthesia. Metformin can also be held before surgery if there is an increased risk of lactic acidosis occurring.

2. The maximum dose of salbutamol per administration is 200 micrograms NOT milligrams.
10107
d e g
a
Case presentation: A 42-year-old woman is admitted to the general surgical ward due to gallstones. It is decided that she should have an outpatient laparoscopic cholecystectomy.


**PH** Depression, hypercholesterolaemia, hypertension, type 2 diabetes mellitus, asthma, chronic fatigue syndrome, allergic rhinitis

**DH** Her current medicines are listed (below). Weight 118kg.

**On Examination**
HR 81/min, BP 112/80mm Hg, RR 14, O2 Sats 96% RA, temperature 37.1

Abdomen soft, tender in RUQ. Bowel sounds present.

**Investigation**

USS abdomen - thickened gallbladder wall and multiple gallstones within the gallbladder. No perforation.

Question 1: Select the THREE prescriptions that are most likely to be stopped before her elective surgery (mark them with a tick in column A)

Question 2: Select the ONE prescription that contains a serious dosing error (mark it with a tick in column B).