Dunedin 2019 trial

Question 1

In the medical treatment of Cushing’s syndrome, what drugs

1. Suppress production of glucocorticoids
2. Glucocorticoid receptor antagonists
3. Adrenolytics
4. Somatostatin analogue

Answer 1

1. Ketoconazole, metyrapone
2. Mifepristone
3. Mitotane
4. Pasireotide

Question 2

Mechanism of enterococci resistance to vancomycin

Answer 2

Alternatiion of cell wall struction from d-ALA-d-ALA to d-ALA-d-LAC

Question 3

Mechanism of resistance of MRSA against methicillin

Answer 3

Modified penicillin-binding protein

Question 4

The 4 types of hypersensitivity reactions

Answer 4

1. Immediate
2. Cytotoxic/antibody (e.g. GPA)
3. Immune complex (e.g. serum sickness, RA)
4. Delayed/cytotoxic - T cell (e.g. contact dermatitis)

Question 5

What is autoimmune polyendocrine syndrome type I and what is the genetic defect?

Answer 5

Clinical syndrome: chronic candidiasis as well as autoimmune polyendocrinopathy, most commonly hypoparathyroidism and adrenal insufficiency, and skin dystrophy

Genetics deficit: AIRE deficiency - The autoimmune regulator gene (AIRE) normally deletes self-reactive T lymphocytes in the maturation phase.

Question 6

What immunophenotype characterises a Reed-Sternberg cell?

Answer 6

CD 15 and 30

Question 7

MOA of ethosuximide

Answer 7

Inhibitin of voltage gated calcium channels

Question 8

What are the locations and functions of

1. Zona glomerulosa
2. Zona reticularis
3. Zona fasciculata

Answer 8

1. Zona glomerulosa - mineralcorticoid (outer)
2. Zona reticularis - glucocorticoid (middle)
3. Zona fasciculata - androgens (inner)

Question 9

Clinical features and genetic deficit for Noonan syndrome

Answer 9

Short stature and cardiomyopathy/pulmonary stenosis

Autosomal dominant - Pathogenic variant in one of many other genes encoding a protein of the Ras-mitogen-activated protein kinase (Ras-MAPK) pathway

Question 10

Edwards syndrome clinical features and genetic defect

Answer 10

Horseshoe kidney, index finger overlapping third and fifth finger overlapping fourth.

Trisomy 18

Question 11

Where does uveal melanoma most commonly metastasise to?

Answer 11

Liver

Question 12

Castleman’s disease - clinical features and cause

Answer 12

peripheral lymphadenopathy and systemic symptoms including fever, night sweats, weight loss, and fatigue, accompanied by nearly universal anemia, thrombocytosis or thrombocytopenia, hypoalbuminemia, polyclonal hypergammaglobulinemia, and an elevated C-reactive protein or erythrocyte sedimentation rate

High IL-6

Question 13

Which antiplatelets are irreversible inhibitors of P2Y12?

Answer 13

Clopidogrel and prasugrel

Question 14

Bartter syndrome

Answer 14

Thick ascending limb of the loop of Henle

Mimics chronic ingestion of loop diuretics

Growth and mental retardation, hypokalaemia, metabolic alkalosis, hypercalciuria (nephrocalcinosis)

Question 15

What drug can mimic Bartter’s syndrome?

Answer 15

Aminoglycosides - they can act as calcimimetics and can activate the CaSR

Question 16

Gitelman syndrome

Answer 16

Autosomal recessive

Mutation in the NCT of distal tubule

Hypokalaemia, metabolic alkalosis, hypocalciuria (differentiates from Bartter)

Question 17

What drug mimcs Gitelman syndrome?

Answer 17

Long term thiazide use

Question 18

Liddle’s syndrome

Answer 18

Autosomal dominant

Gain of function mutation in EnaC in the collecting tubules

Similar findings as mineralcorticoid excess - hypertension, hypokalaemia, metabolic lkalosis

Question 19

Gordon’s syndrome

Answer 19

Familiar hyperkalaemic hypertension with metabolic acidosis

Question 20

Management of PML

Answer 20

Stop immunosuppression and steroids

Question 21

Diagnostic criteria for myeloma

Answer 21

serum protein >30g/L or bone marrow plasma cells >10%

Question 22

CRITERIA FOR ACUTE TRANSPLANTATION (King’s College Criteria)

Answer 22

Paracetamol induced fulminant hepatic failure

pH < 7.3 or INR > 6 (PT > 100s)
+

Cr > 300mmol/L
+

grade III or IV encephalopathy

Non-paracetamol induced fulminant hepatic failure

INR > 6 (PT > 100s) or any 3 of the following variables:

(1) age < 10 or > 40 yrs
(2) aetiology – non A, non B hepatitis, halothane hepatitis, idiosyncratic drug reactions
(3) duration of jaundice before encephalopathy > 7 days
(4) INR > 3.5 (PT > 50s)
(5) bilirubin > 0.3mmol/L

Question 23

When to chose CABG > PCI in stable angina?

Answer 23

Multivessel disease with diabetes

Question 24

Answer 24

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)

Question 25

How to classify as high risk for colorectal cancer screening

Answer 25

Asymptomatic people who have:

at least three first-degree or second-degree relatives with CRC, with at least one diagnosed before age 55 years

OR

at least three first-degree relatives with CRC diagnosed at any age.