UK Clinical Guidelines & Prescribing Safety Flashcards

According to NICE guidance (NG12), which patients should be referred on a 2-week wait (suspected cancer) pathway for colorectal cancer?

Answer: Patients aged 40 or over with unexplained rectal bleeding; OR aged 60 or over with change in bowel habit; OR aged 40 or over with iron deficiency anaemia without an obvious cause

NICE NG12 criteria for 2WW colorectal referral include: ≥40 with unexplained rectal bleeding; ≥50 with unexplained abdominal pain or weight loss; ≥60 with change in bowel habit; ≥60 with iron deficiency anaemia; any age with rectal mass/unexplained iron deficiency anaemia. Haemorrhoids are not an automatic exclusion for referral if other criteria are met.

A 30-year-old woman with newly diagnosed mild-to-moderate ulcerative colitis (proctosigmoiditis) should be offered which first-line treatment according to NICE guidelines?

Answer: Topical aminosalicylate (mesalazine suppository or enema) ± oral aminosalicylate

NICE (NG130) recommends first-line treatment for mild-to-moderate UC as topical mesalazine (suppository for proctitis, enema for proctosigmoiditis) with or without oral mesalazine. Oral steroids are used for moderate-to-severe disease or insufficient response. Immunosuppressants are for maintenance of remission or steroid-dependent disease.

According to NICE guidance on sepsis (NG51), what is the 'Sepsis Six' hour-1 bundle for a patient with suspected sepsis?

Answer: High-flow oxygen, blood cultures, IV broad-spectrum antibiotics, IV fluid bolus, lactate measurement, and urine output monitoring

The Sepsis Six (to be completed within 1 hour): (1) High-flow O2; (2) Blood cultures; (3) IV broad-spectrum antibiotics; (4) IV fluid bolus (500ml crystalloid if hypotensive); (5) Serum lactate; (6) Urine output monitoring (catheterise if needed). Early completion reduces sepsis mortality significantly.

A patient presents with an acute severe asthma attack (SpO2 91%, PEFR 35% predicted, RR 30, pulse 125). According to BTS guidelines, what is the most appropriate immediate management?

Answer: High-flow oxygen, back-to-back nebulised salbutamol + ipratropium, oral/IV prednisolone, and hospital admission

BTS/SIGN asthma guidelines for acute severe attack: high-flow O2 (target SpO2 94–98%), back-to-back (or continuous) nebulised salbutamol + ipratropium bromide every 20–30 minutes, systemic steroids (prednisolone 40–50mg oral or IV hydrocortisone 100mg), and admission. IV magnesium sulphate is added for life-threatening features.

According to NICE guidance, which patients with community-acquired pneumonia should be considered for hospital admission using the CRB-65 score?

Answer: Patients with CRB-65 score ≥2 should be considered for hospital admission; score of 1 requires clinical judgement

CRB-65 (Confusion, Respiratory rate ≥30, BP systolic 7 mmol/L and is used in hospital settings.

A 70-year-old woman with osteoporosis has a T-score of -2.8 on DXA scan and has had one vertebral fracture. According to NICE guidelines, what is the most appropriate treatment?

Answer: Bisphosphonate (e.g., alendronate) plus calcium and vitamin D

NICE (TA160/TA161) recommends bisphosphonates (alendronate is first-line) for women with osteoporosis (T-score ≤-2.5) confirmed on DXA scan, particularly those with a prior fragility fracture. Calcium and vitamin D should be co-prescribed. Denosumab or other agents are second-line if bisphosphonates are not tolerated or contraindicated.