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MRCP 2 > Anatomy/investigations > Flashcards

Anatomy/investigations Flashcards

1
Q

Vessel location w Contralateral homonymous hemianopia

A

Posterior cerebral artery if with macular sparing / visual agnosia

Middle cerebral artery if w Contralat hemiparesis and sensory loss, upper extremity > lower, aphasia

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2
Q

Anterior Vs posterior inferior cerebellar artery

A

BOTH sudden onset vertigo and vomiting

Anterior: ipsilat facial paralysis and deafness

Posterior: ipsilat facial PAIN and temp loss, contralat limb pain and temp loss, ataxia

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3
Q

Jejunal biopsy shows deposition of macrophages containing PAS-positive granules

A

Whipple’s (Tropheryma whippelii infection)

oral co-trimoxazole for a year

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4
Q

homonymous quadrantanopias

A

PITS

Parietal-Inferior, Temporal-Superior

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5
Q

Imaging for ? Parathyroid adenoma

A

Sestamibi parathyroid scan

technetium99 labelled

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6
Q

Central retinal vein Vs artery occlusion

A

Vein is severe retinal haemorrhage, cheese and Pizza🍕

Artery is cherry red spot 🍒 on pale retina

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7
Q

Management of SAH

A

CT intracranial angiogram to identify if aneurysm or AVM etc

. If aneurysm then can be treated with coil

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8
Q

histoplasmosis diagnosis

A

Fine needle aspirate and Groccott strain

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9
Q

massive extradural haemorrhage, most likely caused by.,.

A

ruptured middle meningeal artery.

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10
Q

Echinococcus granulosus

A

hydatid liver disease

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11
Q

signs of Syringomyelia

A

‘cape-like’ (neck and arms) distribution, loss of sensation to TEMP but preservation of light touch, proprioception and vibration

collection of CSF within the spinal cord
symps due to crossing spinothalamic tracts in the anterior commissure

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12
Q

description of syringomyelia anatomy

A

collection of CSF within the spinal cord

symps due to crossing spinothalamic tracts in the anterior commissure

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13
Q

brachial neuritis presentation

A

acute onset of unilat (occasionally bilat) severe pain, followed by shoulder and scapular weakness several days later
Can be after vaccine

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14
Q

X-rays: ‘rain-drop skull’ (likened to the pattern rain forms after hitting a surface and splashing, where it leaves a random pattern of dark spots)

A

multiple myeloma

slightly different from in primary hyperparathyroidism - ‘pepperpot skull’

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15
Q

increased signal in the left temporal lobe, confined predominantly to the grey matter

A

herpes simplex encephalitis

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16
Q

Which nerve weakness causes wrist drop?

A

Radial nerve weakness

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17
Q

Which nerve compression causes deltoid weakness and patch of sensory distrubance over upper outer arm?

A

Axillary nerve compression

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18
Q

weakness of left triceps

sensory impairment of third digit of his left hand and index / ring fingers.

A

C7 nerve root compression

Median nerve compression would not give triceps weakness.

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19
Q

Tensilon test

aka edrophonium chloride test

A

myasthenia gravis

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20
Q

tests for myasthenia gravis

A

Tensilon test: IV edrophonium reduces muscle weakness temporarily - not commonly used any more due to the risk of cardiac arrhythmia

single fibre electromyography: high sensitivity (92-100%)

around 85-90% of patients have antibodies to acetylcholine receptors. In the remaining patients, about about 40% are positive for anti-muscle-specific tyrosine kinase antibodies

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21
Q

Which blood tests could confirm anaphylaxis?

A

mast cell tryptase immediately, 1-2h for peak
get third baseline sample after >24h

peaks at 1-2h
half-life is roughly 2h
but remain elevated for up to 12h

22
Q

what mutation causes polycythaemia vera

A

JAK 2 V617F mutation in 95%

JAK2 exon 12 mutation much rarer

23
Q

what investigations would you expect in Wilson’s

A

slit lamp examination for Kayser-Fleischer rings (only found in 50% but v specific)
REDUCED serum caeruloplasmin
REDUCED total serum copper (counter-intuitive, but 95% of plasma copper is carried by ceruloplasmin)
free (non-ceruloplasmin-bound) serum copper is increased
increased 24hr urinary copper excretion

24
Q

investigation for Haemochromatosis

A 
raised transferrin saturation index
raised ferritin and iron
low TIBC
liver biopsy: Perl's stain
C282Y and H63D mutations
25
Q

liver biopsy: Perl’s stain

A

Haemochromatosis (diagnosed by transferrin saturation)

Sideroblastic anaemia shows Perl’s stain on blood film

26
Q

most specific sign for Wilson’s

A

slit lamp examination for Kayser-Fleischer rings (only found in 50% but v specific)

27
Q

urate levels in gout

A

15% of people w gout have Normal levels

25% of normal pop have raised levels

28
Q

bloods in anorexia

A

Everything is low…
Except G and C
Cholesterol, Carotinaemia, Cortisol, Growth hormone, salivary Glands,

29
Q

‘Tear-drop’ poikilocytes on blood film

A

Myelofibrosis

30
Q

Schistocytes (‘helmet cells’) RBC fragments on blood film

A 
Intravascular haemolysis
TTP
HUS
Mechanical heart valve
DIC
31
Q

Heinz Bodies on blood film

A

G6PD deficiency

Alpha-thalassaemia

32
Q

mnemonic for raised anion gap metabolic acidosis

normal anion gap is <16 mmol/L

A

CATMUDPILES

  • Cyanide, carbon monoxide
  • Alcoholic ketoacidosis
  • Toluene
  • Methanol, metformin
  • Uraemia
  • DKA
  • Phenformin, pyroglutamic acid, paraldehyde, propylene glycol, paracetamol
  • Iron, isoniazid
  • Lactate (numerous causes)
  • Ethanol, Ethylene glycol (anti freeze)
  • Salicylates
33
Q

Causes of normal anion gap metabolic acidosis

normal anion gap is <16 mmol/L

A

Addison’s
Bicarbonate loss ( GI or renal)
Chloride excess
Diuretics

34
Q

what is normal anion gap

A

<16 mmol/L

35
Q

what is osmolar gap

A

Osmolar gap = measured osmolality – calculated osmolality

Calculated osmolality = 2Na + Urea + Glucose

> =10 suggests an elevated osmolar gap

36
Q

what is positive Hoover’s Sign

A

Test for functional paralysis

hold under ‘normal’ heel and ask to straight leg raise other leg. Should feel normal heel press down in normal physiology/true paralysis

37
Q

increased echogenicity on liver ultrasound

hepatomegaly
ALT is typically greater than AST

A

Non-alcoholic steatohepatitis

38
Q

angioid streaks
calcification of dermal elastic fibres
yellow papules in flexural areas

A

pseudoxanthoma elasticum

39
Q

helminth that causes river blindess

A

Onchocerca volvulus

tx IVERmectin
rIVER

40
Q

young pt w seizure.

highly specific sign on CT w contrast for sagittal sinus thrombosis

A

empty delta sign at base. triangular shaped dural sinus, that is not filled w white contrast

41
Q

blood film: smudge cells (also known as smear cells)

A

CLL

42
Q

‘tram-track’ appearance on biopsy electron microscope

-subendothelial and mesangium immune deposits of electron-dense material

A

membranoproliferative glomerulonephritis

assx w Hep C

43
Q

pt presents w incoordination, slurred speech, depressed consciousness and nystagmus

takes phenytoin and gliclazide, known to drink

normal serum osmolal, anion gap and ketones and bicarb

A

Alcohol intox and hyperosmolar hyperglycaemic state cause raised osmolality
Methanol causes raised anion gap
Not DKA

So phenytoin toxicity

44
Q

starry sky renal biopsy appearance

A

Post-streptococcal glomerulonephritis
AND
Burkitt’s lymphoma (type of non-hodgkin’s)

45
Q

Blood film analysis comments on hypochromic anaemia with pencil cells, target cells, acanthocytes and Howell Jolly bodies.

A

hypochromic anaemia with the presence of pencil cells: IDA

Target cells, acanthocytes and Howell Jolly bodies: hyposplenism

IDA and hyposplen = coeliac

46
Q

interpretation of IgG HBs Ag

A

cured
if IgG HBc Ag +ve then previously infected
but c negative then immunised

47
Q

interpretation of HBsAg

A

currently have infection

48
Q

test for myasthenia gravis

A

Tensilon test

aka edrophonium chloride test

49
Q

faggot cells

A

Faggot cells are hypergranular promyelocytes, so called because the high concentrations of Auer rods in the cytoplasm give the cells a bundle of sticks appearance

in acute promyelocytic leukaemia

50
Q

Looser’s zones on XR are seen in which condition

A

Osteomalacia…. Translucent bands or pseudofractures

51
Q

What are Aschoff bodies the histological sign of

A

Aschoff bodies are granulomatous nodules found in rheumatic heart fever

MRCP 2 (13 decks)

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