exam paper Flashcards
1
Q
splenomegaly, anaemia and lymph nodes with high wcc and normal plts
A
CLL
2
Q
rash, arthritis and acute glomerulonephritis
A
IgA nephropathy (HSP)
renal biopsy: mesangial deposition of IgA
3
Q
positive anti-hepatitis B surface antibody. negative anti-hepatitis B core IgG antibody
A
previous vaccine
4
Q
positive anti-hepatitis B surface antibody. postitive anti-hepatitis B core IgG antibody. negative hepatitis B surface antigen
A
previous infection
5
Q
positive anti-hepatitis B core IgG antibody
A
false positive hepatitis B serology
6
Q
positive hepatitis B surface antigen
A
chronic hepatitis B infection
7
Q
positive anti-hepatitis B core IgM antibody
A
acute hepatitis B infection
8
Q
venous/arterial thrombosis, recurrent miscarriages, lived reticularis
which condition
which antibodies
A
antiphospholipid syndrome
anticardiolipin antibodies
anti-beta2 glycoprotein antibodies
lupus anticoagulant
9
Q
which bloods would you expect to be abnormal in antiphospholipid syndrome
A
thrombocytopenia
prolonged APTT
10
Q
management of antiphospholipid syndrome
A
primary thromboprophylaxis: low dose aspirin
secondary thromboprophylaxis:
lifelong warfarin
- initially aim INR 2-3
- in recurrent events: if occured whilst on warfarin add aspirin + INR 3-4
11
Q
anticentromere antibody
A
limited systemic sclerosis
12
Q
antimitrochondrial antibodies
A
primary biliary cholangitis (cirrhosis)
13
Q
1 month hx of weight loss, abdominal distension, flatulence and foul-smelling diarrhoea following a visit to india. stool culture negative
A
giardiasis
14
Q
blood analysis in wilsons disease
A
low srum caeruloplasmin
high serum and urine copper
15
Q
first line tx for wilsons disease
A
penicillamine
16
Q
glucose and galactose
A
lactose
17
Q
glucose + glucose
A
maltose
18
Q
glucose and fructose
A
sucrose
19
Q
non-scaly discrete areas of hair loss on the scalp with a history of atopic eczema
A
alopecia areata
20
Q
unilateral dilated pupil
slowly reactive to accomodation but very poorly to light
A
Holmes-Adie pupil
21
Q
bilaterally small pupils, accomodate but do not react to light
what is it associated with
A
argyll-robertonson pupil (ARP)
accommodated reflex present (ARP), pupillary reflex absent (PRA)
associations:
syphilis
DM
22
Q
adult with excessive bleeding over dental extractions and minor procedures + menorrhagia
A
Von willebrand disease
autosomal dominant
23
Q
man with haemarthroses, haematomas, prolonged bleeding time after surgery/trauma
A
haemophilia
A: factor VIII
B: IX
prolonged APTT
24
Q
obstructive picture with emphysema in a young non smoker
A
alpa 1 antitrypsin deficiency
25
most severe phenotype for alpha 1 antitrypsin deficiency
PiZZ genotype
26
older male localised bony pain and significant elevated ALP with normal Ca and phosphate
Paget's disease
tx with bisphosphonates
27
bone pain with low vitamin D, low ca, low phosphate, high ALP. Looser's zones on X-ray
osteomalacia
tx with vitamin D
28
what is the gene abnormality in burkitts lymphoma
what virus is strongly associated with burkitts
c-myc gene translocation (8:14)
EBV strongly implicated in endemic African form
29
risk of chemotherapy with burkitts lymphoma
what can be given to help prevent this
tumour lysis syndrome
rasburicase
30
persistent asymptomatic hyperglycaemia in a patient under 25
MODY maturity-onset diabetes of the young
autosomal dominant
31
adolescent with neck and mediastinal lymphadenopathy
hodgkins lymphoma
32
reed-sternberg cells on lymph node biopsy
hodgkins lymphoma
33
painless lymphadenopathy with B symptoms in the elderly
non-hodgkins lymphoma
34
starry sky appearance on lymph node biopsy
burkitts lymphoma
35
most likely vessel for source of bleedings of haemoptysis
bronchial in 90%
36
single patch on trunk followed 1-2 wks later by more generalised erythematous scaly patches on trunk and upper limbs
pityriasis rosea
37
causes of acute interstitial nephritis
penicillin
rifampicin
nsaids
allopurinol
furosemide
38
macroscopic haematuria in young male following upper resipatory tract infection 1-2 days earlier
IgA nephropathy
39
URTI 2 wks ago, proteinuria with low complement
post-streptococcal glomerulonephritis
40
how does membranous glomerulonephritis normally present
with proteinuria or nephrotic syndrome
41
proteinuria >300mg/mmol, hypoalbuminaemia, oedema
nephrotic syndrome
42
recurrent sweating and hunger with weight gain and low fasting glucose
dx
gold standard initial test
insulinoma
prolonged (72hr) fasting glucose
43
drop in hb 2 weeks after a blood transfusion, fever, jaundice
dx
test to confirm diagnosis
delayed haemolytic transfusion reaction
positive direct antiglobulin test
44
contraindications to flecainide use for AF and SVT
post MI
structural heart disease
sinus node dysfunction
atrial flutter
45
violaceous flat topped papules on the flexor surfaces of the wrists, lower back and ankles. lacy white pattern on buccal mucosa
dx
phenomenon on skin
lichen planus
koebnerisation from traumatised skin
46
cough + haemoptysis. previous hx TB. CXR solid lesion with adjacent crescent-shaped radiolucency
aspergilloma
47
cocaine symptoms
CP, hypertension, agitation, arrhythmias, hyperthermia, rhabdomyolysis
48
important investigation for non-healing superficial ulcer over the medial malleolus
mx
venous ulcer
ABPI
Mx: compression bandaging
49
diagnostic test for small bowel bacterial overgrowth syndrome
risk factors
hydrogen breath test
risk factors:
neonates with congenital gastrointestinal abnormalities
scleroderma
diabetes
50
progressive exertional dyspnoea, bibasal fine end-inspiratory crepitations, dry cough, clubbing
pulmonary fibrosis
51
spirometry and TLCO (transfer factor) for pulmonary fibrosis
FEV1 normal/decreased
FVC decreased
FEV1/FVC increased
reduced transfer factor
52
what condition is most commonly associated with primary sclerosing cholangitis
ulcerative colitis
53
mechanism of action of clopidogrel
inhibits binding of adenosine diphosphate
54
mechanism of action of aspirin
cox 1 inhibitor - inhibts prodcution of thromboxane
55
4 main diagnostic criteria of hereditary haemorrhagic telangiectasia
- telangiectasia
- epistaxis
- viseral lesions eg gastrointestinal telangiectasia, AVM
- family hx
56
mode of inheritance of hereditary haemorrhagic telangiectasia
autosomal dominant
57
features of common perineal nerve injury
foot drop
other features:
weakness of dorsiflexion, foot eversion and extensor hallucus longus
sensory loss over dorsum of foot and lower lateral part of leg
wasting of anterior tibial and peroneal muscles
58
features of lateral hemisection of the spinal cord
- ipsilateral weakness below lesion
- ipsilateral loss of proprioception and vibration sensation
- contralateral loss of pain and temperature sensation
59
tx for tricyclic overdose complications (hypotension and arrhythmia)
sodium bicarbonate
60
reduced conscious level, reduced respiratory rate and small pupils
opioid toxicity
61
which immunoglobulin is responsible for hyperacute rejection
IgG
62
headache + increasing drowsiness, focal neurological signs and seizures shortly post partum
venous sinus thrombosis
63
gold standard test for venous sinus thrombosis
MRI venography
64
mx for restless leg syndrome
dopamine agonists are first-line (eg pramipexole, ropinirole)
65
compares ordinal, interval or ratio scales of unpaired data
Mann-whitney U test
66
compares two sets of observations on a single sample eg before and after test on same population
wilcoxon signed rank test
67
used to compare proportions or percentages - expected vs observed results
chi-squared test
68
parametric test (can be measured) for paired and unpaired data comparisons
student t-test
69
headache, eye pain, nausea, halos and reduced visual acuity, dilated unreactive pupil. Ciliary vessel hyperaemia
acute angle closure glaucoma
70
lucid period with head trauma
extradural haematoma
71
older person with fall and luctuating confusion/consciousness
subdural haemorrhage
72
triad of ataxia, internal and external ophthalmoplegia and areflexia
dx
which antibodies associated
Miller Fisher syndrome
anti-GQ1B antibodies
73
which infection often triggers Guillin-Barre syndrome
campylobacter jejuni
74
calcium pyrophosphate crystals
dx
microscopic appearance
pseudogout
rhomboid with postitive birefringence
75
monosodium urate crystals
dx
microscopic appearance
gout
needle shaped negatively birefringent
76
colonic ca with endocarditis
causative organism?
strep gallolyticus (s.bovis)
77
endocarditis <2 months post prosthetic valve surgery
causative organism?
coag-neg staph - staph epidermidis
78
abx that increased risk of tendon damage
quinolones eg ciprofloxacin
79
first line ix for acromegaly
serum IGF-1 levels
oral glucose tolerance test (OGTT) to confirm diagnosis if IGF-1 is raised
80
most serious complication of systemic sclerosis
interstitial lung disease and pulmonary HTN
81
PEP regime for needdlestick exposure to HIV
three drug antiretroviral tx for 1 month
82
criteria for PEP for chickenpox in at risk groups
1. significant exposure
2. at risk group - immunosuppressed, neonates, pregnant
3. no antibodies to varicella virus
83
PEP for chicken pox in at risk group
varicella-zoster immunogolbulin (VZIG)
84
first line PEP for chickenpox in pregnant women
oral aciclovir
85
receptive dysphasia, dyslexia, inattention, sensory impairments, gestermann syndrome (finger agnosia, acalculia, agraphia, left-right limb disorientation)
which lobe infarct
parietal lobe infarct
86
normal function of BRCA 1
tumour suppressor gene
87
CSF
low glucose (<1/2 plasma)
high protein
neutrophils
bacterial
88
CSF:
glucose60-80% plasma
protein normal/raised
high lymphocytes
viral
89
theophylline overdose presentation within 1 hr
tx
activated charcoal
90
most sensitive test for showing goitre causing breathlessness
pulmonary function tests - respiratory flow-volume loop
91
features of constrictive pericarditis
-dyspnoea
-right heart failure: hepatomegally firstly, raised JVP, ascites, oedema
-pericardial knock
-kussmaul sign positive (raised JVP on inspiration)
92
cause of MI post-partum in a young patient with no risk factors
coronary artery dissection
93
most common cause of large painless rectal bleed in child
meckels diverticulum
94
what condition is primary biliary cholangitis most commonly associated with
sjogrens syndrome
also
rheumatoid arthritis
systemic sclerosis
thyroid disease
95
which layer of skin does lipodermatosclerosis affect
hypodermis
96
Waterloo score use
assess the risk of development of a pressure sore
97
test for screening for diabetic nephropathy
albumin:creatinine ratio
98
why is oral prednisolone contraindicated in erythroderma
risk of prescipitating generalised pustular psoriasis
99
most common cardiac abnormality associated with elastin deficiency
aortic supravalvular stenosis
100
which protein is deficient in marfans
fibrillin
101
most common complication of marfans
dilation of the aortic sinuses leading to aortic aneurysm, aortic dissection and aortic regurgitation
102
stress and excessive exercise causing amenorrhoea
hypothalamic amenorrhoea
103
which consition is most strongly associated with H.pylori
duodenal ulcers
also gastric ulcers and gastric carcinoma, B cell lymphoma, atrophic gastritis but to a lesser extent
104
mx of h.pylori
7 day course of PPI + amoxicillin + clarithromycin/metronidazole
105
causes of pulsus paradoxus
severe asthma
cardiac tamponade
106
what is a single nucleotide polymorphism
subsitiution of a nucleotide for any other nucleotide
107
positional claudication pain better on sitting and walking uphill
lumbar spinal stenosis
108
most common cause of nephrotic syndrome
minimal change disease
109
management of minimal change disease
oral corticosteroids
110
hyponatraemia with low serum osmolality, high urine osmolality and high urinary sodium
SIADH
111
primary mechanism of action of antipsychotic drugs
dopamine receptor antagonism
112
rhythm control post cardioversion for AF
beta blocker (not sotalol) first line
then:
amiodarone > propafenone >sotalol/ flecainide
113
lethargy, weakness, weight loss and hyperpigmentation
addisons
114
mechanism of action of ISMN
nitric oxide donor
increased cyclic guanosine monophosphate production
115
which clotting factors does warfarin act on
1972
10, 9, 7 and 2
116
which antibiotics cause QT prolongation
erythromycin, clarithromycin, moxifloxacin, fluconazole, ketoconazole
117
bone pain with low vitamin D, low Ca and phosphate and raised ALP
osteomalacia
secondary to low vitamin D
118
bones, stones, abdominal groans, and psychic moans
raised Ca
low phosphate
PTH raised/normal
primary hyperparathyroidism
119
weakness worsening with activity and improving with rest with facial involvement
myasthenia gravis
120
progressive proximal muscle weakness without sensory impairment with raised CK
polymyositis
121
raised ALT with raised IgG
autoimmune hepatitis
122
CURB65 score of 0-1
mx
community management with Po abx (unless social reasons or unstable comorbid illness)
123
CURB65 score of 2
mx
hospital admission
124
CURB65 score 3 or more
mx
higher level of care may be required
125
patients >60 with non-visible haematuria and dysuria or raised WCC
what should these patients be investigated for and how
r/o urological ca with cystoscopy and renal tract imaging
126
what conditions is MEN 1 associated with
pituitary pancreas and parathyroid lesions
127
early diastolic murmur, collapsing pulse, wide pulse pressure
aortic regurgitation
128
fever, pleuritic pain, pericardial effusion and raised ESR 2-6 weeks post MI
Dresslers syndrome (pericarditis)
129
persistent ST elevation following recent MI with no CP
left ventricular aneurysm
130
causes of a S3 (third heart sound)
normal if <30 (<50 for women)
left ventricular failure
constrictive pericarditis
mitral regurgitation
131
causes of S4 (fourth heart sound)
HOCM
HTN
aortic stenosis
132
hypertension, hypokalaemia, metabolic acidosis, raised aldosterone
primary hyperaldosteronism
133
causes of upper zone fibrosis
C - coal workers pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - ankylosing spondylitis
R - radiation
T - TB
S - silicosis/ sarcoidosis
134
hyperpigmentation of the palmer creases
addisons disease
135
triad of sudden onset severe abdominal pain, hepatomegaly and ascites
Budd-Chiari syndrome - hepatic vein thrombosis
136
patient with HIV/ heroin user presents with nephrotic syndrome
dx
focal segmental glomerulosclerosis
137
oral ulcers, genital ulcers, anterior uveitis
Behcet's syndrome
138
first line tx for chronic HF
ACE-inhibitor + beta blocker
139
