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MRCP 2 > Cardio/resp/renal > Flashcards

Cardio/resp/renal Flashcards

1
Q

Sumatriptan cardiac risk?

A

Vasospasm -> dull chest pain

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2
Q

Cardiovascularly stable with broad complex tachy. Previous episodes of SVT with underlying LBBB
Rx?

A

Adenosine

[likely SVT again]

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3
Q

FEV1 cut off for pneumonectomy

A

<2L

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4
Q

Long QT + congenital deafness

A

Jervell-lange-neilson syndrome

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5
Q
A

LUL collapse

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6
Q

ABPI to require US and arteriogram

A

<0.5

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7
Q

Clicking sound which is synchronous with heartbeat with normal CXR= ? Rx? How could you make Dx?

A

Small apical pneumothorax

If well - analgesia and follow-up in the clinic

Lateral decubitus CXR

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8
Q

55F
Wheeze, hot flushes worse with alcohol. Haemoptysis
=? rx?

A

Bronchial carcinoid

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9
Q

20M
Hypertrophied calves, weakness in proximal muscles. Heart failure
Raised CK

A

Becker muscular dystrophy
[Presents as mild duchenne which would be bad by age 5]

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10
Q

Progressive muscle weakness with increase tone and cardiac conduction defects

A

Myotonic dystrophy

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11
Q

Poorly controlled heart failure despite optiomal medication
now ECG shows?
RX?

A

LBBB
Cardiac resynchronisation therapy defibrilator

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12
Q

Dialysis long term now with gut motility issues / carpal tunnel?

A

Beta2-microglobulin deposition

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13
Q

Flu like symptoms then significant pneumonia = ? rx?

A

Staph

Fluclox
linezolid if allergic

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14
Q

What are the absolute indications for insertion of a chest drain in an effusion after aspiration?

A

Organisms on gram stain / culture
Frank puss
LDH >1000
pH <7.2
Glucose <3.3

[Organisms or 1, (7.)2, 3.3]

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15
Q

Work with metals and now restrictive Lung fibrosis

A

Berylliosis

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16
Q

Brady cardia with compromise. What would dose of adrenaline be if you had no atropine

A

2-10mcg IV

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17
Q

AF when anticoagulate? Score points?

A

≥2 for men or ≥3 for women is “moderate-high” risk and should otherwise be an anticoagulation candidate.

Chadsvasc
congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74 and sex category (female)

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18
Q

Symptomatic AS, what needs to happen before AVR?

A

Coronary angiography - as may need CABG at time of operation

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19
Q

Previous TB and had an operation - what does this show?

A

Thoracoplasty - removal of ribs to a collapsed ara of lung

[Upper lobe ectomy would have elevated right hemidiaphragm and displacement of right hilum]

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20
Q

CURB65 points for?

A

Age > 65
confusion <9 on AMTS
Urea > 7
RR > 30
BP <90 Systolic or <60 diastolic

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21
Q

Pseudomonas pneumonia rx? second line?

A

Oral quinolone eg cipro OR
IV Tazocin

IV colistin second line

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22
Q

Obstructive LFTs how to differentiate COPD and Asthma

A

Transfer factor
COPD - likely low
Asthma - normal or raised

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23
Q

COPD mild mod severe FEV1

A

mod 50-70%
severe 30-49%
very severe <30%

(mild 70-80% with symptoms of cough / sob]

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24
Q

ANCAs ?

A

PR3 (C) ANCA - Granulomatosis with polyangitis

MPO (P) ANCA - Churg

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25
Q

Which diabetic drugs worsen heart failure

A

thiazolidinediones Eg pioglitazone

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26
Q

Aspergilloma rx in healthy? with poor functional status

A

Lobectomy

Bronchial artery embolisation

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27
Q

Intermittent catheterisation with bacteruria but no evidence of sepsis rx?

A

Increase fluids + catheter change frequency

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28
Q

Nodular rash on shins, fatigue breathlessness =? rx?

A

Sarcoid
Pred

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29
Q

CFTR mutation is

A

DF508

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30
Q

‘crazy paving’ pattern on CT
Bronch - PAS positive proteinaceous fluid

A

Pulmonary alveolar proteinosis

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31
Q

Following needle aspiration of a pneumothorax, when would you put in a chest drain

A

Still >1cm

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32
Q

Mitral valve prothesis with clot and features of shock

A

IV alteplase - OR surgery if available

If stable - IV heparin

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33
Q

Who gets a 6-week CXR following CAP

A

All >50
persistence of symptoms

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34
Q

RTA - reason? K? Conditions? Which can have urinary ph lowered by increasing acid load?
Type 1
Type 2
Type 4

A

Type 1 distal - Failure of H+ secretion
Autoimmune conditions/amphoB/liver disease
HypoK
Osteomalacia, renal stones, Nephrocalcinosis

Type 2 proximal - Bicarb wasting
Wilsons / heavy metal / myeloma / amyloid
HypoK
Uric acid stones, ostomalacia
-Urinary pH lowered with increasing Acid load

Type 4 - reduced aldosterone/resistance
HyperK
Addisons / long term NSAID

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35
Q

Test for orthostatic hypotension

A

Tilt table test

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36
Q

Blind but denying they can’t see?

A

Cortical blindness - eg bilat occipital infarcts

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37
Q

pneumonia with autoimmune haemolytic anaemia

A

Mycoplasma pneumonia
clarithromycin

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38
Q
A

Left lower lobe collapse

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39
Q

ASD and tricuspid defect in a baby

A

ebsteins abnormality

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40
Q
A

LBBB
M shaped in aVL
Notched R in 1
Monophasic R in v6

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41
Q

Palmar xanthoma =

A

dysbetalipoproteinaemia

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42
Q

What do they get

A

Yellow nail syndrome
Bronchiectasis
Pleural effusions
lymphoedema

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43
Q

20s Episodes of collapse

A

Long QT - Romano ward syndrome most likely

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44
Q

CKD with low Ca and raised PTH first line Rx

A

Alphacalcidol

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45
Q

GPA which ANCA

A

cANCA

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46
Q

PR3 antibodies in

A

GPA

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47
Q

50s wheeze and SOB. CXR peripheral infiltrates
Raised IgG and eosinophils =

A

Chronic eosinophilic pneumonia

Allergic bronchopulmonary aspergilliosis would have raised IgE not IgG

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48
Q

Silent chest, exhaustion, cyanosis and arrythmia are all life threatn=ening asthma. What are the values also included
PO2, PCO2, SPO2, PEF

A

PO2 <8
PCO2 4.6-6 (Normal )
spo2 <92%
pef <33%

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49
Q

dominant
HTN, HypoK, alkalosis and low renin / aldosterone = ? rx?

A

Liddle
Amiloride

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50
Q

CKD then MRI with contrast now thickened skin and reduced joint movements

A

Nephrogenic systemic fibrosis

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51
Q

ECG which shows decreasing QRS amplitude from v1-v6, RAD, ?
What condition do they often have

A

Dextrocardia
Often get bronchietasis

52
Q

Psuedomonas in sputum rx

A

Any of:
3rd generation cef - eg ceftazidime
meropenem
azetreonam

53
Q

Noonan syndrome
JVP prominent A waves
Soft systolic murmur left sternal edge
pitting oedema

A

Pulmonary stenosis
[evidence R sided HF]

54
Q

primary pulm HTN
Rx if positive acute vasoreactivity testing?
negative?

A

Positive CCB eg amlidipine
Negative - PDE5 Inhibitor

55
Q

Chronic cough and abnormal ECG which syndrome?

A

Kartageners
Dextrocardia and bronciectasis

56
Q

Which in RIPE should not be given with chronic liver disease

A

Pyrazidamine

57
Q
A

Bronchiectasis

58
Q

Preg with Sx of PE but no concern 1st line Ix?

A

CXR
Then either CTPA (more risk to mother)
or VQ scan (more risk to fetus)

59
Q

Demonstrates?

A

Concave = obstructive

60
Q
A

PE - Right heart strain
A large S wave in lead I,
Q wave in lead III
inverted T wave in lead III §

61
Q

Wilsons with increase urinary bicarb loss? Which other syndrome common to cause this type

A

RTA type 2
fanconi syndrome

62
Q

Recent thrombolysis for MI
Now shocked BP, raised JVP

A

ECG - electeral alterans with tachy
= Tamponade

needs cardiocentesis

63
Q

angina 1st line rx for long term

A

B blocker
or CCB

64
Q

Taking cocaine

A

AVNRT
Absence of p waves and pseudo r wave in v1

65
Q

Chronic colonised with pseudomonas in CF and now worsening next line?

A

6 months azithro

66
Q

Describe sarcoid granuloma

A

Prominent epitheliod cells with sparse lymphocytic infiltrate at the margins

67
Q

SVT terminated now this which is?

68
Q

1st line immunoupressant for systemic sclerosis

A

Mycophenolate

69
Q

Farmer with pulm fibrosis

A

Extrinsic allergic alveolitis

70
Q

Nephrotic syndrome in older adult

71
Q

Infertile, cough, sinusitis,

A

Kartegener syndrome
look at heart

72
Q

RBBB and ST elevation in right precordil leads following episode of VF is

73
Q

Fertility in CF

A

Men 98% infirtile
women can get preg

74
Q

Rheumatic heart disease and asthma in new fast AF

A

IV verapamil

75
Q

Flash pulmonary oedema and HTN in <50?
>50?

A

<50 Fibromuscular dysplasia

> 50 renl artery stenosis

[Q should give renal function]

76
Q

Bar splinter haemorhhages and olser / Janeway - other finding of IE

A

Microscopic haematuria

77
Q

DVT, cerebral aneurysm, oral ulcers and anterior uveitis

78
Q

Pain on exercise with passing dark urine after? key ix?

A

McArdle syndrome
Muscle biposy
[CK too]

79
Q

SIADH getting fluid restriction. 3 days in level still 125 rx?

A

Demeoxycline

80
Q

sarcoid granulomas stimulate

A

1-alpha hydroxylase
[leads to increased vit D and calcium absorption ]

81
Q

Myastenia what Ix is most commonly positive

A

EMG 95%
Anti Ach 85%
Anti Musk 10%

82
Q

Symptoms of ectopics bothersome but normal enough heart?

A

Bisoprolol for symptom control

83
Q

Bloods in HSV encephalitis

A

Normal WCC raised CRP

84
Q

Vaccine followed by pain in shoulder and 1 sided weakness

A

Brachial neuritis

85
Q

Jamacain with bihilar lymphadeonpathy on CXR + sx of cardiac failure next iX

86
Q

Sx of heart failure with normal ejection fraction?

A

Restrictive cardiomyopathy

87
Q

Nephrotic syndrome treated then couple weeks later mild pyrexia and sudden deterioration in renal function

A

Renal vein thrombosis

88
Q

Trauma -> surgical emphysema and pleural effusion with mild raised amylase

A

Oesophageal rupture

89
Q

tilt table test -> 4s pause rx

A

Dual chamber pace maker

90
Q

hilar mass suspicious of malignancy on CXR ix in order?

A

CT
Then bronch

91
Q

CURB rx

A

1 - oral home
2 - IV
3 - hdu

92
Q

CKD5 with rapid progressive sclerosis cause?

A

galoinium exposure (angio)

[b-2-microglobin is slow sx]

93
Q

Pericarditis stepwise rc

A

NSAID
Colchicine
Pred

94
Q
A

U waves in V2-5 most obvious
[Small deflection following T wave]

95
Q

benzbromarone for gout issue

A

Increases urate excretion -> increased urate renal stones

96
Q

FHx CV disease
Raised LDL/Triglycerides =? rx? 2nd?

A

Familial combined hyperlipidaemia
Statin 1st line
[eZETIMBE second]

[Fibrates added for hypertriglyceridemia really high or only things raised]

97
Q
A

Mesothelioma at L apex
Plaques on diaphragm

98
Q

Loss of vision then common peroneal palsy
ANCA negative
Livido reticularis
Renal aneurysms

99
Q

LTOT in COPD in those with PaO2 <8 + what?

A

Peripheral oedema
Polycythemia (HCT >55%)
or Pulm HTN

[Peri, poly, pulm]

100
Q

Colonic Ca removal and now endocarditis 1 week later but strep bovis not an option

A

Bacteroides fragilis

101
Q

Presents as CF but with low protein and normal albumin

A

X linked hypogammaglobulinaemia

102
Q
A

RVH

Right axis deviation (+150 degrees).
Dominant R wave in V1 (> 7 mm tall; R/S ratio > 1)
Dominant S wave in V6 (> 7 mm deep; R/S ratio < 1).
Right ventricular strain pattern with ST depression and T-wave inversion in V1-4.

103
Q

Asx new diagnosis of mobitz type 1 block rx?

104
Q

Marfans with 2.5cm PTX stable

105
Q

High altitude pulm odema rx ? 2nd?

A

High concentration O2
nifedipine second line

106
Q

High altitude pulm odema rx ? 2nd?

A

High concentration O2
nifedipine second line

107
Q

Key Ix for coarctation

108
Q

Sickle cell which RTA

109
Q

Few syncopal sensations and QT 0.49s rx

110
Q

Make diagnosis of AIN

111
Q

IHD LVF COPD in stable fast AF borderline low BP

A

IV digoxin

112
Q

MI 2 weeks later pyrexic with raised ESR cardiomegaly and pericardial effusion = ? rx?

A

Dresslers
Aspirin 650mg QDS

113
Q

Angina Rx if already on BB and CCB

A

Ivabradine / nitrate

114
Q

slow aortic root dilation in marfans

A

Bisoprolol

115
Q

Previous chemoradio now SOB
ECG - small voltage QRS
Decrease of BP on inspiration

A

Pericardial effusion

116
Q

When can you diagnose obestety hypoventilation syndrome

A

BMI >30
PCO2 >6.5 during the DAY
[absence of other causes eg opioids]

[They may have coexistent OSA!]

117
Q

Alports gets a renal transplant and then few months later rapidly worsening renal function and kidney failed

A

Anti GBM disease (both collagen IV]

118
Q

30s weight loss and new murmur with episodes of collapse. Murmur variable on position. clubbing
Calcification on CXR

A

Atrial myexoma

119
Q

30s weight loss and new murmur with episodes of collapse. Murmur variable on position. clubbing
Calcification on CXR

A

Atrial myxoma

120
Q

Definitive Dx of sarcoid

A

Transbronchial biopsies

[not endobronchial]

121
Q

COPD on Salbutamol. Next line if
No reversibility?
Reversibility?

A

None - LAMA + LABA

Some - LABA + ICS

122
Q

SOBOE with noisy breathing Ix

A

Flow volume loop - likely upper airway

123
Q

LVF on ramipril. Worsening sx and evidence of overload on exam next line

A

Spironolactone [both better heart and diuretic]

124
Q

FVC for respiratory support in gillian barre

A

<20ml/kg

eg 50kg = 1L

125
Q
A

LLL collapse
sail sigh - double heart border

126
Q

Jewish, nephrotic syndrome, severe fevers, arthritis

A

Familal mediterranian fever

127
Q

MRCP 2 (5 decks)

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