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MRCP > Clinical science > Flashcards

Clinical science Flashcards

1
Q

Canakinumab MOA?

A

targets IL-1 beta

- used in systemic JIA, adult onset Still’s

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2
Q

what organs are in direct contact with the left kidney?

A
  • Left suprarenal gland
  • Pancreas
  • Colon
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3
Q

what organs are in direct contact with the right kidney?

A
  • Right suprarenal gland
  • Duodenum
  • Colon
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4
Q

p53 gene is located on which chromosome?

A

17p

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5
Q

role of p53 tumour suppressor?

A

preventing entry into the S phase until DNA has been checked and repaired.
- key regulator of apoptosis

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6
Q

What is responsible for rapid depolarisation of myocardial cells?

A

rapid sodium influx

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7
Q

What is responsible for early repolarisation of myocardial cells?

A

efflux of K+

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8
Q

What is responsible for the plateau before full repolarisation of myocardial cells?

A

slow influx of calcium

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9
Q

what is responsible for final repolarisation of myocardial cells?

A

efflux of K+

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10
Q

what is responsible for restoration of ionic concentrations of myocardial cells?

A

resting potential restored by Na+/K+ ATPase

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11
Q

What part of the heart is responsible for the fastest conduction?

A

purkinje fibres

- large diameter, velocities of 2-4m/s

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12
Q

IX of homocystinuria?

A
  • Increased homocysteine levels in serum and urine

- cyanide-nitroprusside test: *also + in cystinuria

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13
Q

Mx of homocystinuria?

A

Pyridoxine Vit B6 supplements

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14
Q

Causes of increased lung compliance?

ie. greater change in lung volume/ unit change in airway pressure

A
  • age

- emphysema - this is due to loss alveolar walls and associated elastic tissue

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15
Q

Causes of decreased lung compliance?

ie. decreased change in lung volume/ unit change in airway pressure

A
  • pulmonary oedema
  • pulmonary fibrosis
  • pneumonectomy
  • kyphosis
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16
Q

Function of leukotrienes?

A
  • mediates inflammation/ allergic reactions
  • causes bronchoconstriction, mucous production
  • increases vascular permeability, attracts leukocytes
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17
Q

Leukotriene in NSAID induced bronchospasm in asthmatics?

A

NSAID induced bronchospasm in asthmatics is secondary to the express production of leukotrienes due to the inhibition of prostaglandin synthetase

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18
Q

Which technique would be most suitable to detect and quantify a viral protein?

A

Western blot

  • detects *PROTEINS using gel electrophoresis
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19
Q

Function of Vit D?

A
  • increases plasma calcium + phosphate
  • increases renal tubular reabsorption and gut absorption of calcium
  • increases osteoclastic activity
  • increases renal phosphate reabsorption
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20
Q

Characteristic features of Rubella maternal infection in babies?

A

S.H.E.

  • Sensorineural deafness
  • Eyes: Congenital cataracts, Glaucoma
  • Congenital heart disease (e.g. patent ductus arteriosus)
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21
Q

Characteristic features of Toxoplasmosis maternal infection in babies?

A
  • Cerebral calcification
  • Chorioretinitis
  • Hydrocephalus
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22
Q

Characteristic features of CMV maternal infection in babies?

A
  • Growth retardation

- Purpuric skin lesions

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23
Q

Differences between Toxoplasmosis and CMV maternal infection in baby?

A

Toxo: hydrocephalus
CMV: microcephaly

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24
Q

What cells are mostly responsible for creating granulomas?

A

macrophages

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25
Q

what cytokine is the main agent in macrophage activation?

A

IFN-gamma

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26
Q

Which cytokines are responsible for neutrophil chemotaxis?

A

IL-8, TNF alpha

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27
Q

which cytokines induce fever?

A

IL-1, IL-6, TNF-alpha

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28
Q

Which cytokine is an anti-inflammatory cytokine?

A

IL-10

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29
Q

MOA of growth hormone?

A
  • acts on transmembrane R for growth factor
  • binding of GH -> receptor dimerization
  • acts directly on tissues + indirectly via IGF-1
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30
Q

where is IGF-1 primarily secreted?

A

liver

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31
Q

what decreases/ inhibits GH secretion?

A

glucose, somatostatin

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32
Q

What are funnel plots used for?

A

primarily to demonstrate existence of publication bias in meta-analyses

  • treatment effects on horizontal axis, study size on vertical axis
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33
Q

Interpretation of a funnel plot?

A

a symmetrical inverted funnel shape (ie. triangle) -> suggests publication bias is unlikely.

if asymmetrical: indicates rs between tx effect and study size, indicating either publication bias or a systematic difference between larger and smaller studies

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34
Q

Features of Fabry disease?

A
  • burning pain/paraesthesia in childhood- triggered by stress/heat/cold
  • angiokeratomas
  • lens opacities
  • proteinuria
  • early cardiovascular disease
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35
Q

genetics of Fabry disease?

A

X linked recessive -> deficiency of alpha-galactosidase A

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36
Q

proteinuria + early strokes/ MI + rash known as angiokeratomas?

A

Fabry disease

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37
Q

Subcortical infarcts and leukoencephalopathy + history of migraines and multiple strokes?

A

CADASIL

cerebral auto dominant arteriopathy with subcortical infarcts

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38
Q

MELAS =?

A

mitochondrial encephalopathy with lactic acidosis and stroke symptoms

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39
Q

what are the 5 layers of the epidermis?

A
  1. stratum corneum
  2. stratum lucidum
  3. stratum granulosum
  4. stratum spinosum
  5. stratum germinativum - the basement membrane
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40
Q

which layer of the epidermis gives rise to keratinocytes/ contain melanocytes?

A

bottom layer- stratum germinativum

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41
Q

which layer of the epidermis is the thickest layer of epidermis?

A

stratum spinosum

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42
Q

what type of receptors does adrenaline work on?

A

G-protein coupled receptors

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43
Q

mitochondrial diseases known for…?

A

poor genotype: phenotype correlation -

within a tissue or cell, there can be different mitochondrial populations (aka heteroplasmy)

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44
Q

Examples of Mitochondrial diseases?

A
  • Leber’s optic atrophy
  • MELAS
  • MERRF: myoclonus epilepsy with ragged red fibres
  • Kearns- Sayre: external ophthalmoplegia, retinitis pigments, ptosis
  • sensorineural hearing loss
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45
Q

muscle biopsy classically shows ‘red, ragged fibres’ due to increased number of mitochondria

A

mitochondrial diseases

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46
Q

most common renal abnormality in Turner’s syndrome

A

Horseshoe kidney - occur in 10%.

  • usually causes higher risk of ureteropelvic junction obstruction +/- UTI
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47
Q

Fanconi syndrome features / investigation findings?

A
  • glucose +++ Protein ++ on urinalysis
    (due to Proximal tubular cells not reabsorbing glucose and aas)
  • HypoK, HypoCa, HypoPO4
    (failed reabsorption of electrolytes)
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48
Q

what part of the kidney is implicated in Fanconi syndrome?

A

proximal convoluted tubule

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49
Q

Features of phenylketonuria?

A
  • usually presents by 6 mo with developmental delay
  • classically fair hair, blue eyes
  • learning difficulties
  • seizures, typically infantile spasms
  • eczema
  • “musty” odour to urine and sweat
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50
Q

Defect in phenylketonuria?

A

defect in phenylalanine hydroxylase

- leading to high levels of phenylalanine *neurotoxic

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51
Q

what cell type mediates hyper acute organ rejection?

A

B cells

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52
Q

What cell types mediate acute/ chronic organ rejection?

A

T cells

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53
Q

features of Bartter’s syndrome?

A
  • metabolic alkalosis
  • low Na, K, Cl
  • polyhydramnios typical in neonatal form
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54
Q

gene defect assoc w Li-Fraumeni?

A

p53

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55
Q

which part of the cell cycle determines the length of the cell cycle?

A

G1

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56
Q

shortest phase of the cell cycle?

A

M phase: mitosis

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57
Q

brown/bluish pigment of the ear cartilage or sclera, arthropathy, renal stones, cardiac valve involvement and coronary calcification.

A

Alkaptonuria

  • auto reccessive
  • elevated Homogentisic acid (HGA) which polymerises and deposits in connective tissue throughout the body
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58
Q

features of alkaptonuria?

A
  • pigmented sclera
  • urine turns black if exposed to air
  • intervertebral disc calcification may result in back pain
  • renal stones
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59
Q

pathophysiology of alkaptonuria?

A

auto recessive. build up of toxic HGA (Homogentisic acid)

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60
Q

treamtent of alkaptonuria?

A

high dose vit c, dietary restriction of phenylalanine and tyrosine

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61
Q

what complement deficiency causes one to be particularly prone to Neisseria meningitidis infection?

A

C5-9

- encodes the MAC

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62
Q

what complement deficiency predisposes to Leiner disease: recurrent diarrhoea, wasting, seborrheic dermatitis?

A

C5 deficiency

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63
Q

E.g.s of Type IV T cell mediated hypersensitivity reactions?

A
  • Tuberculosis / tuberculin skin reaction
  • Graft versus host disease
  • Allergic contact dermatitis
  • Scabies
  • Extrinsic allergic alveolitis (especially chronic phase)
  • Multiple sclerosis
  • Guillain-Barre syndrome
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64
Q

Examples of type V mediated hypersensitivity reactions?

A

Graves disease, myasthenia gravis

  • antibodies that bind cell surface receptors and either block/ stimulate
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65
Q

equation for standard error of the mean?

-ie. measure of the spread expected for the mean of the observations.

A

SEM = Standard deviation/ Square root (n= sample size)

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66
Q

What is the lower/ upper limit of a 95% confidence interval?

A

LOWER LIMIT: mean - (1.96 * SEM)

Upper limit: mean + (1.96 * SEM)

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67
Q

what percentage of values lie within 1/ 2/ 3 SD of the mean?

A
  1. 3% - 1 SD
  2. 4% - 2 SD
  3. 7% - 3 SD
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68
Q

equation relating standard deviation from variance?

A

SD = square root (variance)

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69
Q

Homocystinuria features?

A
  • fine fair hair
  • Arachnodactyly, marfinoid, osteoporosis/ kyphosis
  • neuro: LD, seizures
  • ocular: myopia, inferonasal lens dislocation
  • increased risk of VTE/ arterial clot
  • malar flash/ libero reticularis
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70
Q

Diabetic nephropathy histological findings?

A

Kimmelstiel-Wilson lesions, nodular glomerulosclerosis

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71
Q

what nerves go through the optic canal?

A

CN II - optic

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72
Q

What nerves go through the superior orbital fissure?

A

CN III, IV, V1, VI

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73
Q

what nerves go through the inferior orbital fissure?

A

Zygomatic nerve and infraorbital nerve of maxillary nerve (CN V2), Orbital branches of the pterygopalatine ganglion

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74
Q

what nerve goes through the foramen rotundum?

A

CN V2 - maxillary nerve

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75
Q

what nerve goes through the foramen ovale?

A

mandibular nerve - CNV3

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76
Q

what nerves go through the jugular foramen?

A

CN IX, X, XI

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77
Q

what statistical test is used to compare proportions or percentages following 2 different interventions?

A

Chi squared test

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78
Q

What cell receptor is a co-receptor for MHC Class I molecules?

A

CD8

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79
Q

what cell receptor is a co-receptor for MHC Class II molecules?

A

CD4

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80
Q

what cell receptor is expressed on Reed-Sternberg cells?

A

CD15, CD30

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81
Q

what cell receptor is receptor for EBV?

A

CD21

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82
Q

What cell receptor acts as the FAS receptor involved in apoptosis?

A

CD 95

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83
Q

immunological changes seen in progressive HIV infection?

A

increased B2-microglobulin, polyclonal B cell activation.

- decreased CD4, IL-2, NK cell function, reduced delayed hypersensitivity responses.

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84
Q

what hormone lowers appetite?

A

leptin

- produced by adipose tissues, works on satiety centres in the hypothalamus

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85
Q

what hormone increases appetite?

A

ghrelin

  • produced mainly by the P/D1 cells lining the fundus of the stomach and epsilon cells of the pancreas.
  • Ghrelin levels increase before and decrease after meals
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86
Q

northern blotting used to..?

A

detect RNA

SNOW- DROP

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87
Q

Southern blotting used to…?

A

detect DNA

SNOW - DROP

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88
Q

what stage of the cell cycle is under p53 influence (regulating apoptosis)?

A

G1

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89
Q

What does endothelin do?

A

potent, long acting vasoconstrictor and bronchoconstrictor

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90
Q

what promotes release of endothelin?

A
  • angiotensin II
  • ADH
  • hypoxia
  • mechanical shearing forces
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91
Q

what inhibits release of endothelin?

A
  • nitric oxide

- prostacyclin

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92
Q

where is endothelin secreted from?

A

secreted initially as a prohormone by the vascular endothelium
- later converted to ET-1 by endothelin converting enzyme.

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93
Q

what stimulates respiration in the central chemoreceptors of the brain??

A

raised [H+] (more acidic)

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94
Q

what stimulates respiration in the peripheral chemoreceptors of the body??

A

carotid + aortic bodies: raised pCO2 & [H+],

to a lesser extent low pO2

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95
Q

what is the Hering-Bruer reflex?

A

lung distension causes slowing of respiratory rate

sensed by stretch receptors

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96
Q

Management of Fabry disease?

A

enzyme replacement therapy with agalsidase alfa (alpha-galactosidase A.)

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97
Q

the addition of mannose-6-phosphate to proteins designates transport to which organelle?

A

lysosome

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98
Q

what does trop T bind to?

A

tropomyosin,

forming a troponin-tropomyosin complex

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99
Q

what does Troponin C bind to?

A

calcium ions.
- trop C is released by damage to both skeletal and cardiac muscle, making it an insensitive marker for myocardial necrosis

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100
Q

what does Troponin I bind to?

A

binds to actin,

to hold the troponin-tropomyosin complex in place,
specific to myocardial damage

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101
Q

how to calculate odds?

A

number of people who incur a particular outcome / no of ppl who do not incur the outcome..

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102
Q

odds ratio?

A

odds ratio = ratio of odds of a particular outcome with experimental treatment and that of control

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103
Q

how to calculate pulse pressure?

A

systolic pressure - diastolic pressure

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104
Q

factors which increase pulse pressure?

A
  • less compliant aorta (tends to occur w advancing age),

- increased stroke volume

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105
Q

how to calculate systemic vascular resistance?

A

mean arterial pressure/ cardiac output

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106
Q

How to calculate likelihood ratio for a positive test result?

A

sensitivity/ (1- specificity)

  • how much the odds of the disease increases by when test is positive
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107
Q

How to calculate likelihood ratio for a negative test result?

A

(1- sensitivity)/ specificity

  • how much the odds of the disease decreases by when test is negative
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108
Q

mean/ median/ mode for Normal distributions?

A

mean = median = mode

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109
Q

mean / median/ mode for positively skewed distributions?

A

mean > median > mode

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110
Q

mean / median/ mode for negatively skewed distributions?

A

mean < median < mode

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111
Q

which part of the antibody binds to antigens?

A

Fab (antigen-binding fragment) region

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112
Q

which part of the antibody binds to immune cells?

A

Fc region (fragment crystallisable region- tail region of an antibody that interacts with cell surface receptors)

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113
Q

conditions assoc w HLA-DR3?

A
  • dermatitis herpetiformis
  • Sjogren’s syndrome
  • primary biliary cirrhosis
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114
Q

HLA- A3?

A

haemochromatosis

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115
Q

HLA-B51?

A

Behcet’s disease

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116
Q

HLA-B27?

A
  • ank spond
  • reactive arthritis
  • acute ant uveitis
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117
Q

HLA-DQ2/8?

A

Coeliac

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118
Q

HLA-DR2?

A

narcolepsy, Goodpastures

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119
Q

HLA-DR4?

A
  • T1DM

- Rheumatoid arthritis (in particular DRB1 gene)

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120
Q

oncogene assoc with neuroblastoma?

A

n-MYC

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121
Q

oncogene assoc with follicular lymphoma?

A

BCL-2

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122
Q

oncogene assoc with MEN?

A

RET oncogene

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123
Q

dry beri beri?

A

peripheral neuropathy

  • secondary to thiamine deficiency
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124
Q

conditions assoc with thiamine deficiency?

A
  • Wernicke’s encephalopathy: nystagmus, ophthalmoplegia and ataxia
  • Korsakoff’s syndrome: amnesia, confabulation
  • dry beriberi: peripheral neuropathy
  • wet beriberi: dilated cardiomyopathy
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125
Q

mitochondrial inheritance + rapid onset visual loss?

A

Leber’s hereditary Optic neuropathy

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126
Q

stroke like episodes + seizures + lactic acidosis?

A

MELAS- mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes.
- mitochondrial inheritance

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127
Q

what is the Bohr effect in respiratory physiology?

A

Increasing acidity or pCO2 -> O2 binds less well to Hb

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128
Q

What is the Haldane effect in respiratory physiology?

A

increased pO2 means CO2 binds less well to Hb

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129
Q

what chromosome has the genes for HLA antigens?

A

chromosome 6

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130
Q

most common genetic cause of Prader-Willi syndrome?

A

microdeletion of paternal 15q11-13 (70% of cases)

131
Q

what significance test is appropriate to calculate correlation between two things?

A

Spearman’s rank correlation coefficient, Kendall rank

132
Q

mitochondrial inheritance +
onset < 20-years-old +
external ophthalmoplegia +
retinitis pigmentosa

A

Kearns-Sayre syndrome

133
Q

which cell surface protein is used by HIV to enter T cells?

134
Q

what is intention to treat analysis?

A

analyse all data, regardless of whether they completed/ received the treatment.

  • to avoid effects of crossover and drop-out
135
Q

Which part of the renal tubule is impermeable to water?

A

ascending limb of loop of Henle

136
Q

what increases absorption of iron in the gut?

A

vit c, gastric acid

137
Q

what decreases absorption of iron in the gut?

A

PPI, tetracycline, gastric achlorhydria, tannin (found in tea)

138
Q

developmental delay and cherry red spot on the macula, without hepatomegaly or splenomegaly

A

Tay-Sachs disease

  • accumulation of GM2 ganglioside within lysosomes
139
Q

hepatosplenomegaly + cherry red spot on the macula

A

Niemann-Pick disease

140
Q

hepatosplenomegaly + aseptic necrosis of the femur

A

Gaucher’s disease

- accumulation of glucocerebrosidase in brain, liver, spleen

141
Q

Maxillary nerve goes through?

A

foramen rotundum

142
Q

Mandibular nerve goes through?

A

foramen ovale

143
Q

X linked dominant conditions?

A

Alports syndrome
Rett syndrome
Vit D resistant rickets

144
Q

what occurs in phase I drug metabolism?

A

oxidation, reduction, hydrolysis

145
Q

what occurs in phase II drug metabolism?

A

conjugation

146
Q

Drugs exhibiting zero-order kinetics?

e.g. enzyme saturated

A

phenytoin
salicylates (e.g. high-dose aspirin)
heparin
ethanol

147
Q

Drugs affected by deficiency in hepatic N-acetyltransferase?

A 
isoniazid
procainamide
hydralazine
dapsone
sulfasalazine
148
Q

causes of oculogyric crises?

A

antipsychotics, metoclopramide, postencephalitic Parkinsons disease

149
Q

mx of oculogyric crisis?

A

IV benztropine/ procyclide (antimuscarinic)

150
Q

Infliximab MOA? used in?

A

anti-TNFa

  • used in rheumatoid arthritis, Crohn’s
151
Q

Rituximab MOA? used in?

A

anti-CD20

  • used in Rheumatoid arthritis, non-Hodgkins lymphoma
152
Q

Cetuximab MOA? used in?

A

Epidermal growth factor receptor antagonist

  • used in metastatic colorectal cancer, H+N cancer
153
Q

Trastuzumab MOA? used in?

A

HER2/ neu receptor antagonist

- used in metastatic breast ca

154
Q

Alemtuzumab MOA? used in?

A

anti-CD52.

- used in CLL

155
Q

OKT3 MOA? used in?

A

anti-CD3.

- used to prevent organ rejection

156
Q

IV sodium bicarb in lithium toxicity?

A

works to increase urinary alkalinity to promote lithium excretion

  • preferred treatment in severe cases would be haemodialysis
157
Q

what abx is CI in G6PD deficiency?

A

ciprofloxacin

158
Q

e.g.s of mixed alpha and beta antagonists?

A

carvedilol, labetalol

159
Q

alpha 1 blocker?

160
Q

alpha 1 a blocker?

A

tamsulosin - acts mainly on urogenital tract

161
Q

alpha 2 blocker?

162
Q

non selective alpha blocker?

A

phenoxybenzamine

163
Q

beta 1 blocker?

164
Q

non selective beta blocker?

A

propranolol

165
Q

fomepizole MOA?

A

competitive inhibitor of alcohol dehydrogenase

166
Q

How does COHb affect the oxygen dissociation curve?

A

left shift of oxygen dissociation curve

167
Q

causes of drug induced thrombocytopenia?

A
  • quinine
  • abciximab
  • NSAIDs
  • diuretics: furosemide
  • antibiotics: penicillins, sulphonamides, rifampicin
  • anticonvulsants: carbamazepine, valproate
  • heparin
168
Q

which electrolyte abnormalities predispose to digoxin toxicity?

A

hypoK,
HypoMg,
HyperCa, HyperNa

169
Q

alpha 1 agonist?

A

phenylephrine

170
Q

alpha 2 agonist?

171
Q

beta 1 agonist?

A

dobutamine

172
Q

Moa of digoxin?

A

inhibition of Na/K ATPase pump

173
Q

first line therapy for hypotension or arrhythmias in TCA OD?

A

IV bicarbonate

174
Q

management of motion sickness?

A
  1. hyoscine (transdermal patch)
  2. cyclizine (antihistamine)
  3. Sedating- promethazine
175
Q

Aspirin MOA?

A

blocks Cox 1 and COX2

  • > blocks thromboxane A2 formation in platelets
  • > decreases ability of platelets to aggregate
176
Q

blood test to monitor LMWH?

A

anti-factor Xa levels

177
Q

blood test to monitor heparin?

178
Q

heparin induced thrombocytopenia- what are antibodies formed against?

A

complexes of platelet factor 4 (PF4) and heparin

179
Q

drugs that commonly cause urticaria?

A

aspirin,
penicillins,
NSAIDs,
opiates

180
Q

features of organophosphate insecticide poisoning?

A
  • inhibition of acetylcholinesterase -> upregulation of cholinergic neurotransmission
  • Salivation
  • Lacrimation
  • Urination
  • Defecation/ diarrhoea
  • CV: bradycardia, hypotension
181
Q

What CV effects are seen in organophosphate insecticide poisoning?

A

bradycardia, hypotension

182
Q

management of organophosphate insecticide poisoning?

183
Q

Drugs known to cause impaired glucose tolerance?

A
  • thiazides, furosemide
  • steroids
  • tacrolimus, ciclosporin
  • IFN-alpha
  • nicotinic acid
  • antipsychotics
  • beta blockers can cause a slight impairment
184
Q

management of accidental injection of adrenaline?

A

local infiltration of phentolamine

185
Q

what electrolyte changes does Adrenaline have on the body>

A

hyperglycaemia, high lactate, hypokalaemia

186
Q

Pilocarpine MOA?

A

muscarinic agonist

187
Q

uses of somatostatin?

A
  • acute treatment of variceal haemorrhage
  • acromegaly
  • carcinoid syndrome
  • prevent complications following pancreatic surgery
  • VIPomas
  • refractory diarrhoea
188
Q

SE of somatostatin?

A

gallstones - secondary to biliary stasis

189
Q

management of cocaine-induced hypertension?

A

benzodiazepines + sodium nitroprusside

190
Q

management of cocaine-induced chest pain?

A

benzodiazepines + GTN

191
Q

King’s College Hospital criteria for liver transplantation (in paracetamol OD)?

A

Arterial pH <7.3, 24h after ingestion

OR all of the following:

  • PT >100 seconds
  • Cr >300
  • Grade III/ IV encephalopathy
192
Q

What is the most appropriate time to take blood samples for therapeutic monitoring of phenytoin levels?

A

trough levels, immediately before dose

193
Q

E.g.s of Class Ia antiarrhythmics?

A
  • Quinidine
  • Procainamide
  • Disopyramide

MOA- bocks Na channels, increases AP duration

194
Q

E.g.s of Class Ib antiarrhythmics?

A
  • Lidocaine
  • Tocainide
  • Mexiletine

MOA- bocks Na channels, increases AP duration

195
Q

E.g.s of Class Ic antiarrhythmics?

A
  • Flecainide
  • Encainide
  • Propafenone

MOA- bocks Na channels, no effect on AP duration

196
Q

E.g.s of Class II antiarrhythmics?

A

Propranolol
Atenolol
Bisoprolol
Metoprolol

MOA: Beta blockers

197
Q

E.g.s of Class III antiarrhythmics?

A
  • Amiodarone
  • Sotalol
  • Ibutilide
  • Bretylium

MOA: blocks K+ channels

198
Q

E.g.s of Class IV antiarrhythmics?

A
  • Verapamil
  • Diltiazem

MOA: CCB

199
Q

Cardiovascular effects of cocaine use?

A
  • coronary artery spasm → myocardial ischaemia/infarction
  • both tachycardia and bradycardia may occur
  • hypertension
  • QRS widening and QT prolongation
  • aortic dissection
200
Q

Neurological effects of cocaine toxicity?

A
  • seizures
  • mydriasis
  • hypertonia
  • hyperreflexia
201
Q

Psychiatric effects of cocaine toxicity?

A

agitation
psychosis
hallucinations

202
Q

systemic effects of cocaine toxicity?

A
  • ischaemic colitis
  • met acidosis
  • rhabdo
  • hyperthermia
203
Q

Nivolumab MOA? used in?

A

PD-1 (programmed cell death) inhibitor.

  • used in lung cancer
204
Q

SE of ciprofloxacin?

A
  • lowers seizure threshold -> more seizures
  • tendon damage/ rupture
  • cartilage damage (hence, generally avoided in children)
  • lengthens QT
205
Q

Contraindications for ciprofloxacin?

A

Breastfeeding/ Pregnancy

- G6PD

206
Q

MOA of tamsulosin?

A

Alpha 1a Blocker

207
Q

Drugs that can be cleared with haemodialysis?

A

BLAST

  • Barbiturate
  • Lithium
  • Alcohol (inc methanol, ethylene glycol)
  • Salicylates
  • Theophyllines (charcoal haemoperfusion is preferable)
208
Q

Drugs which cannot be cleared with haemodialysis?

A
  • TCAs
  • benzodiazepines
  • dextropropoxyphene (Co-proxamol)
  • digoxin
  • beta-blockers
209
Q

Causes of low Mg?

A
  • Drug: diuretics, PPI
  • TPN
  • Diarrhoea
  • Alcohol
  • HypoK
  • HyperCa: Ca + Mg compete for transport in the thick ascending limb of the loop of Henle
  • Gitelmans/ Bartter’s metabolic disorders
210
Q

Gentamicin Contraindications?

A

myasthenia gravis

211
Q

which calcium channel blocker causes constipation as a side effect?

212
Q

which antibiotic inhibits DNA synthesis?

A

quinolone e.g. ciprofloxacin

213
Q

which antibiotic damages DNA?

A

metronidazole

214
Q

flecainide in patients with heart failure?

A

contraindicated in structural heart disease e.g. heart failure,
+ has a negative inotropic and pro arrhythmic effect

215
Q

Features of mercury poisoning?

A
  • parasthesiae
  • visual field defects
  • hearing loss
  • irritability
  • renal tubular acidosis
216
Q

Adverse effects of allopurinol?

A

most significant ones are dermatological, stop immediately if they develop a rash:

  • SCAR (severe cutaneous adverse reaction)
  • DRESS (drug reaction with eosinophilia and systemic symptoms)
  • stevens johnson syndrome
217
Q

what ethnicities are at increased risk of dermatological side effects of Allopurinol?

A

chinese, Thai, Korean

218
Q

what ix should be done if worried about high risk of severe cutaneous adverse reaction when starting allopurinol?

A

screen for HLA-B*5801 allele

219
Q

Causes of serotonin syndrome?

A
  • MAO inhibitors
  • SSRIs. + St John’s Wort
  • ecstasy
  • amphetamines
220
Q

features of serotonin syndrome?

A
  • neuromuscular excitation e.g. myoclonus, rigidity, hyperreflexia
  • hyperthermia
  • altered mental state
221
Q

management of serotonin syndrome?

A

supportive, IV fluids

  • benzos
  • severe: serotonin antagonists e.g. cyproheptadine, chlorpromazine
222
Q

management of severe serotonin syndrome?

A

serotonin antagonists

e.g. cyproheptadine, chlorpromazine

223
Q

contraindications of flecainide?

A
  • post MI
  • structural heart disease. e.g. heart failure
  • sinus node dysfunction, 2nd degree or greater AV block
  • atrial flutter
224
Q

management of symptomatic bradycardia secondary to OD if not responding to atropine?

225
Q

acid/ base status in salicylate/ aspirin OD?

A

mixed met acidosis and resp alkalosis

226
Q

what serum concentration of salicylate is an indication for haemodialysis?

227
Q

what should be investigated prior to commencing trastuzumab?

A

echo - as trastuzumab may be cardiotoxic

228
Q

adverse effects of trastuzumab?

A

flu like symptoms, diarrhoea - common

- cardiotoxicity

229
Q

RUQ pain in someone taking octreotide?

A

biliary stasis and gallstones are a risk

230
Q

brick red skin + smell of bitter almonds + hypoxia, hypotension, headache, confusion?

A

Cyanide poisoning

231
Q

management of cyanide poisoning?

A

100% oxygen,
IV hydroxocobalamin
or IV sodium nitrite and sodium thiosulfate + inhaled amyl nitrite

232
Q

what might increase the risk of cardio toxicity with trastuzumab treatment?

A

anthracyclines

e.g. doxorubicin

233
Q

what are the different pathophysiologies of Amiodarone-induced thyrotoxicosis types 1 and 2?

A

AIT Type 1: Excess iodine-induced thyroid hormone synthesis, goitre present

AIT Type 2: Amiodarone-related destructive thyroiditis, goitre absent

234
Q

management of amiodarone-induced thyrotoxicosis types 1 and 2?

A

Type 1: Carbimazole or Potassium perchlorate

Type 2: corticosteroids

235
Q

Should you continue amiodarone treatment in amiodarone-induced thyrotoxicosis / hypothyroidism?

A

hypothyroidism: can continue
thyrotoxicosis: stop amiodarone

236
Q

good differentiating feature between methanol and ethylene glycol toxicity?

A

methanol toxicity: visual problems, including blindness, due to accumulation of formic acid

237
Q

management of ophthalmological complications with methanol toxicity?

A

cofactor therapy with folinic acid

238
Q

renal impairment: which anti-TB drugs should be adjusted?

A

reduction in Ethambutol dose

239
Q

smoking - effect on liver enzymes?

A

inducer of CYP1A2- smokers require more aminophylline

240
Q

management of ingestion of caustic substances?

A
  • High dose IV PPI

- urgent Upper GI endoscopy to assess degree of ulceration

241
Q

features of quinine toxicity / OD?

A

aka cinchonism

  • cardiac arrhythmia, flash pulmonary oedema (prolongs QRS/ QT)
  • hypoglycaemia
  • tinnitus, visual blurring, flushed and dry skin, abdo pain
242
Q

therapeutic monitoring of ciclosporin?

A

trough levels, immediately before next dose

243
Q

Adverse effects of ciclosporin?

A 
high:
fluid, hypertension, hyperK, hypertrichosis, gingival hyperplasia, hyperlipidaemia.
- nephrotoxicity
- hepatotoxicity
- tremor

impaired glucose tolerance

244
Q

MOA of propofol?

A

GABA agonist

- for rapid onset of anaesthesia

245
Q

agent of choice for rapid sequence of induction due to extremely rapid onset of action?

A

Sodium thiopentone

246
Q

MOA of Ketamine?

A

NMDA receptor antagonist

247
Q

suitable agent for anaesthesia in those who are haemodynamically unstable due to minimal myocardial depression?

248
Q

medication causing blue tinge to vision?

A

sildenafil

- “blue pill”/ blue vision

249
Q

Features suggesting restrictive cardiomyopathy rather than constrictive pericarditis

A
  • prominent apical pulse
  • absence of pericardial calcification on CXR
  • the heart may be enlarged
  • ECG abnormalities e.g. bundle branch block, Q waves
250
Q

1st line management in acute glaucoma when patients have a history of asthma?

A

prostaglandin analogue - latanoprost

251
Q

Evolocumab MOA?

A

prevents PCSK9-mediated LDL receptor degradation.

-> Increasing liver LDLR levels results in associated reductions in serum LDL-cholesterol.

252
Q

End stage renal failure + painful necrotic skin lesions + calcium deposit in skin biopsy

A

Calciphylaxis

  • tx: reducing calcium and phosphate levels
253
Q

what drug contributes to calciphylaxis in end stage renal patients?

254
Q

what increases risk of hepatotoxicity in someone who has taken a paracetamol OD?

A
  • liver enzyme inducing drugs e.g. Rifampicin, chronic alcohol excess
  • malnutrition (depletion of glutathione stores)

*note acute alcohol excess is not assoc w increased risk

255
Q

managing hypothyroidism: what should the TSH be with treatment?

A

0.5 to 2.5 mU/l

256
Q

Ix (First line) of age related macular degeneration?

A

slit-lamp microscopy:

to identify any pigmentary, exudative or haemorrhagic changes affecting the retina

257
Q

ix of choice if wet/ neovascular age related macular degeneration is suspected?

A

fluorescein angiography:
can guide intervention with anti-VEGF therapy.

*may be complemented with indocyanine green angiography to visualise any changes in the choroidal circulation.

258
Q

dacrocystitis = ?

A

infection of the lacrimal sac

259
Q

risk factors of primary open angle glaucoma?

A
  • increasing age
  • family hx
  • Afro-Carrib
  • *myopia
  • hypertension
  • diabetes mellitus
  • corticosteroids
260
Q

starting statin as primary prevention of cardiovascular disease, what aim?

A

aim for a reduction in non-HDL cholesterol of > 40%

261
Q

which glaucoma medications increases uveoscleral outflow?

A
  1. prostaglandin analogues e.g. latanoprost

2. miotics e.g. pilocarpine (muscarinic agonist)

262
Q

which glaucoma medications reduces aqueous production alone?

A
  1. Beta blockers e.g. timolol

2. carbonic anhydrase inhibitors e.g. dorzolamide

263
Q

which glaucoma medication both reduces aqueous production and increases uveoscleral outflow?

A

sympathomimetics e.g. brimonidine, an alpha2 adrenoreceptor agonist

264
Q

e.g. of depolarising muscle relaxant (anaesthetic)

A

suxamethonium

265
Q

e.g.s of non depolarising muscle relaxants

A

atracurium, vecuronium, pancuronium

effects may be reversed by neostigmine

266
Q

Causes of predominantly hypercholesterolaemia, rather than hypertriglyceridaemia?

A
  • nephrotic syndrome
  • cholestasis
  • hypothyroidism
267
Q

conditions associated with retinitis pigmentosa?

A
  • Refsum disease: cerebellar ataxia, peripheral neuropathy, deafness, ichthyosis
  • Usher syndrome
  • abetalipoproteinemia
  • Lawrence-Moon-Biedl syndrome
  • Kearns-Sayre syndrome
  • Alport’s syndrome
268
Q

what drugs may precipitate acute glaucoma?

A

anticholinergics, TCAs

269
Q

Hypoca/ HyperCa leads to cataracts?

270
Q

Gitelman’s syndrome: where is the defect?

A

defect in the thiazide-sensitive Na/Cl transporter in the distal convoluted tubule

271
Q

Features of Gitelman’s syndrome?

A

normotension,

  • HypoK, HypoMg
  • Hypocalciuria
  • met alkalosis
272
Q

Causes of macroglossia?

A
  • hypothyroidism
  • acromegaly
  • amyloidosis
  • Duchenne muscular dystrophy
  • mucopolysaccharidosis (e.g. Hurler syndrome)
273
Q

what causes shift of oxygen to the left? ie. lower affinity to Hb

A

HbF, methaemoglobin, COHb

  • Low [H+]: Alkaline
  • Low pCO2
  • Low 2-3- DPG
  • Low temp
274
Q

what causes shift of oxygen to the right? ie. higher affinity to Hb

A
  • raised [H+]: acidic
  • raised pCO2
  • raised 2,3-DPG
  • raised temp
275
Q

Which adrenoceptor causes inhibition of pre-synaptic neurotransmitter release in response to sympathetic stimulation?

A

alpha 2

  • inhibits adenylate cyclase
276
Q

Which adrenoceptor causes vasoconstriction and relaxation of GI muscle in response to sympathetic stimulation?

A

alpha 1

  • activates phospholipase C → IP3 → DAG
277
Q

first line medication used for agoraphobia?

A

sertraline

278
Q

what statistical measure is used best to analyze survival over time?

A

Hazard ratio

279
Q

what drug is appropriate to sedate someone with acute intermittent porphyria?

A

chlorpromazine

280
Q

Causes of angioid retinal streaks on fundoscopy?

A
  • pseudoxanthoma elasticum
  • Ehler-Danlos
  • Paget’s disease
  • sickle cell anaemia
  • acromegaly
281
Q

what ophthalmological finding is more common in pseudoxanthoma elasticum?

A

angioid retinal streaks

282
Q

causes of Hypokalaemia with hypertension?

A
  • conns
  • cushings
  • Liddle’s syndrome
  • 11 beta hydroxylase deficiency
  • drugs: e.g. carbenoxolone (an anti-ulcer drug), liquorice excess
283
Q

Causes of hypokalaemia without hypertension?

A
  • diuretics
  • GI loss e.g. D+V
  • renal tubular acidosis types 1 and 2
  • Bartter’s syndrome
  • Gitelman syndrome
284
Q

Currently, what are the most common causes of viral myocarditis?

A

Parvovirus B19, HHV 6

285
Q

what medication may reduce vit B12 absorption, causing B12 deficiency?

286
Q

Where is the defect in Bartter’s syndrome?

A

Defective chloride absorption at Na/K/2Cl cotransporter in the ascending loop of Henle.

e.g. like taking large doses of furosemide

287
Q

Features of Bartter’s syndrome?

A
  • presents in childhood
  • polyuria, polydipsia
  • hypoK
  • normotension
  • weakness
288
Q

acute onset of unilateral (occasionally bilateral) severe pain, followed by shoulder and scapular weakness several days later. sensory change minimal

A

brachial neuritis

289
Q

jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules

A

Whipple’s disease

  • caused by Tropheryma whippelii
  • malabsorption, arthralgia, LNpathy, skin hyperpigmentation
290
Q

1st line for generalised anxiety disorder?

A

sertraline

291
Q

drugs that cause photosensitivity?

A
  • thiazides
  • tetracyclines, sulphonamides, ciproflox
  • amiodarone
  • NSAIDs e.g. piroxicam
  • psoralens
  • sulphonylureas
292
Q

What is the best predictor of mortality post-STEMI in treadmill exercise testing?

A

exercise capacity

293
Q

bilateral sensorineural deafness, mild hypothyroidism, goitre ?

A

Pendred syndrome

- auto recessive

294
Q

Tx of Pendred syndrome?

A

thyroid hormone replacement + cochlear implants

295
Q

MX of oculogyric crisis?

A

IV antimuscarinic: benztropine or procyclidine

296
Q

1st line mx for diabetic peripheral neuropathy?

A

duloxetine

297
Q

what foods interact with monoamine oxidase inhibitors and might cause a hypertensive reaction?

A

tyramine containing foods e.g. cheese, pickled herring, Bovril, Oxo, marmite, broad beans

298
Q

MOA of naftidrofuryl which may be used for peripheral vascular disease?

A

5-HT2 receptor antagonist

299
Q

what medication should not be prescribed with statins if there is a history of myalgia (due to risk of muscle toxicity)?

300
Q

Which type of thyroid cancer is most assoc with the RET oncogene?

A

medullary

  • RET oncogene assoc MEN 2
301
Q

Features of Noonan’s syndrome?

A

seen as ‘Male turners’

  • auto dominant
  • cardiac: pulmonary valve stenosis
  • coagulation: fXI deficiency
302
Q

MOA of amiloride?

A

blocks the epithelial sodium channel in the distal convoluted tubule

  • weak diuretic, usually given with thiazides/ loop diuretics
303
Q

what medication is associated with the unmasking of Churg-strauss syndrome?

A

montelukast

304
Q

Genetics of Liddle’s syndrome?

A

auto dominant

- disorder sodium channels in the distal tubules leading to increased sodium reabsorption

305
Q

Features of Liddle’s syndrome?

A

Hypertension + hypoK alkalosis

306
Q

Management of Liddle’s syndrome?

A

amiloride/ triamterene

307
Q

What is the main action of atrial natriuretic peptide?

A

vasodilation

308
Q

Irinotecan: MOA of this cytotoxic drug?

A

inhibits topoisomerase I which prevents relaxation of supercoiled DNA

309
Q

e.g.s of centrally acting antihypertensive?

A
  • methyldopa
  • moxonidine
  • clonidine
310
Q

what increases the risk of fluid retention in patients on pioglitazone?

A

if patients are also taking insulin

311
Q

what is pre-test probability?

A

prevalence

- proportion of people at risk at a specific time (point prevalence) or time interval (period prevalence)

312
Q

What is post-test probability?

A

the proportion of patients w that particular test result who have the target disorder

post test probability = post test odds/ (1 + post-test odds)

313
Q

Pre test odds - what is it?

A

the odds that the patient has the target disorder before the test is carried out

pre-test odds = pre-test probability / (1 - pre test probability)

314
Q

post-test odds?

A

post test odds= pre test odds x likelihood ratio

315
Q

Features of galactosaemia?

A 
jaundice
failure to thrive
hepatomegaly
cataracts
hypoglycaemia after exposure to galactose
Fanconi syndrome
316
Q

painful third nerve palsy?

A

posterior communicating artery aneurysm

317
Q

Associations of yellow nail syndrome?

A
  • congenital lymphoedema
  • pleural effusions
  • bronchiectasis
  • chronic sinus infections
318
Q

Upbeat nystagmus?

A

cerebellar vermis lesion

319
Q

Downbeat nystagmus?

A

Arnold Chiari malformation

- foramen magnum lesions

320
Q

What CN is involved in a hypersensitive carotid sinus reflex?

A

CN IX (Glossopharyngeal)

321
Q

most common cause of death in Friedrich’s ataxia?

322
Q

Difference between Pearson’s correlation coefficient and Spearman’s rank correlation coefficient?

A

Pearson’s correlation coefficient:
- “R” - measure of association between 2 continuous scale measurements

vs

Spearman’s rank correlation coefficient:

  • correlation between ranks of 2 variables
  • for categorical (ordinal) variables
323
Q

regulation of satiety - what controls this in the hypothalamus?

A

ventromedial nucleus of hypothalamus

MRCP (21 decks)

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