Deltamed 2017

Question 1

Timing of revascularisation after NSTEMI

Answer 1

1. Immediate
   
   1. APO, ventricular arrythmias, haemodynamic instability, going ST dynamic changes
2. <12 hours
   
   1. GRACE >140 or TIMI >5
3. <48 hours
   
   1. Everyone else

Question 2

Aminodaroine in p-glycoprotein interactions

Answer 2

Inhibitor

Question 3

Digoxin in P-glycoprotein interactions

Answer 3

Substrate

Question 4

Verapamil in P-glycoprotein interactions

Answer 4

Substrate and inhibitor

Question 5

Dabigatran in P-glycoprotein interactions

Answer 5

Substrate

Question 6

Atorvastatin P-glycoprotein interactions

Answer 6

Substrate, inhibitor

Question 7

St John’s worth and P-glycoprotein interactions

Answer 7

Inducer

Question 8

Grapefruit juice and P-glycoprotein interactions

Answer 8

Inhibitor

Question 9

What is the formula for clearance?

Answer 9

CL = (0.7 x volume of distribution) / half-life

Volume of distribution = dose given / concentration at time 0

Question 10

What method is employed in case controlled studies to reduce randomisation?

Answer 10

Matching

Question 11

What method is used in clinical trials to reduce confounders?

Answer 11

Randomisation

Question 12

What is channeling bias?

Answer 12

When a patient’s prognosis or degree of illness influences which group he or she is put into a study

Question 13

What is the effect of selection bias?

Answer 13

Reduces generalisability

Question 14

What does blinding/masking reduce?

Answer 14

Information bias

Question 15

What is attrition bias and what’s an example of how it occurs?

Answer 15

When participants leave during a study

Losses may be influenced by such factors as unsatisfactory treatment efficacy or intolerable adverse effects

Question 16

What is the genetic defect and clinical characteristics of MODY1?

Answer 16

Mutations in the HNF4A gene on chromosome 20

primary genetic defect in insulin secretion

at risk for the microvascular and macrovascular complications

initial good response to sulfonyureas

Question 17

What is the genetic defect and clinical features of MODY2?

Answer 17

Glucokinase gene - results in a higher threshold for glucose stimulated insulin secretion and insulin secretory deficit

Hyperglycaemia is stable, mild, and is not associated with the vascular complications. Diet controlled

Question 18

What MODY can be adequately controlled with sulfonylurea monotherapy?

Answer 18

mutations in the HNF1A gene on chromosome 12 was formerly called MODY3

Question 19

1. TSH is low and only serum T3 is high (normal free T4 concentration)
2. TSH is low, free T4 is high, and T3 is normal

Answer 19

1. TSH is low and only serum T3 is high (normal free T4 concentration)
   
   1. Graves’ disease or autonomously functioning thyroid adenoma or exogenous T3
2. TSH is low, free T4 is high, and T3 is normal
   
   1. Hyperthyroidism with concurrent nonthyroidal illness, amiodarone-induced thyroid dysfunction, or exogenous T4 ingestion

Question 20

What patients are at risk of HBV reactivation?

Answer 20

HBsAg +ve

HBcAb +ve

Question 21

What is the first line test to investigate for pancreatic insufficiency?

Answer 21

Faecal elastase-1 (low levels)

Question 22

Cancer screening in PSC

Answer 22

1. Cholangiocarcinoma:
   
   1. US or MRI every 6-12 months
2. Bowel cancer
   
   1. W/ IBD colonoscopy every 1-2 years
   2. No IBD colonoscopy every 3-5 years

Question 23

Immediate immunosuppression in GPA or MPA

Answer 23

Pred and rituximab or cyclophosphamide and rituximab

Question 24

What level of complete spinal cord injury would result in acute respiratory collapse

Answer 24

C3 and above (diaphragm C3, 4, 5)

Question 25

What happens to bladder and bowel function in acute spinal cord injuries?

Answer 25

Reflex emptying of the bladder may be lost, resulting in urinary retention and bladder distention. In lesions that occur above the sacral level leaving the spinal bladder center in the conus medullaris intact, automatic, reflex emptying of the bladder returns days to weeks after the injury.

Similarly, bowel function ceases immediately after complete cord transection at any level, with loss of rectal tone and the anal “wink” reflex. Spontaneous bowel peristalsis returns within a few days as a rule, as do the anal and bulbocavernosus reflexes when the cord lesion lies above the sacral level.

Question 26

What is the mechanism of hypercalcaemia in renal cell carcinoma?

Answer 26

Paraneoplastic hypercalcaemia by tumour cells secreting parathyroid hormone related protein

Question 27

What does C4D positive staining indicate in renal transplant biopsy

Answer 27

Antibody mediated rejection

Question 28

MOA of omalizumab

Answer 28

Monoclonal antibody binding to IgE receptor

Question 29

What is the mean sleep latency in narcolepsy?

Answer 29

8min or less