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MRCP > Final deck 1 > Flashcards

Final deck 1 Flashcards

1
Q

What can Japanese encephalitis present with

A

Parkinsonism - sign of basal ganglia involvement

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2
Q

A rise in what parameter can cause pseudohyponatraemia

A

Lipids/triglycerides

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3
Q

What is needed before treated PBS

A

Imaging - MRCP

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4
Q

What area do immune cells bind to on immunolgobulins

A

FC region

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5
Q

Type of GN associated with SLE

A

Diffuse proliferative GN

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6
Q

UTI abx in pregnancy

A

Nitro if NOT close to term
Amox if close to term

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7
Q

Bloods for methaemoglobinaemia

A

Normal pO2 but decreased oxygen saturation is characteristic of methaemoglobinaemia

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8
Q

Treatment for heparin induced thrombocytopenia

A

Stop heparin and start a non-heparinoid based anticoagulant

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9
Q

What is adynamic bone disease

A

When bone losese buffering capacity in those with diabetes or peritoneal dialysis.
High calcium and phosphate with low PTH

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10
Q

Who gets irradiated blood products

A

severe immunodeficiencies
those with a history of Hodgkin’s lymphoma
patients who have been exposed to certain drugs (e.g. bendamustine and fludarabine)
following stem cell transplant.

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11
Q

Why is nephrotic syndrome a hypercoagulable state

A

loss of antithrombin III via the kidneys - increases risk of VTE/Renal vein thrombosis etc

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12
Q

What is Katyama fever and how does it present

A

Acute schistosomiasis infection -

fever, urticarial rash, hepatosplenomegaly and bronchospasm. Symptoms occur four to six weeks after infection and the diagnosis is clinical.

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13
Q

The universal donor of fresh frozen plasma is

A

AB RhD negative blood

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14
Q

Patients with peritonsillar abscesses can develop Lemierre’s syndrome (thrombophlebitis of the IJV), how does it present

A

this can present with neck pain, and can result in septic pulmonary embolism

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15
Q

Treatment for neuroepileptic malignant syndrome

A

Dantrolene and benzos

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16
Q

How does metformin cause GI upset

A

Bile malabsorption

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17
Q

Types of genetic mutations

A

Missense - alteration of necleutide sequence that converts codon of an amino acid to the codon of another amino acid
Insertion - 1 or more nucleotides into DNA
Nonsense - alteration in nucelotide sequences makes a codon a stop codon
Point - single nucelotide change
Read-through - termination codon to a normal codon so does not read the stop codon

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18
Q

Best motion sickness antiemetic

A

Cinnarizine

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19
Q

What increases the risk of infections in haematological cancers?

A

Hypogammaglobulinaemia - deficiency of immunoglobulins (IgA, IgG, and/or IgM) in the blood.

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20
Q

Causes of Methaemoglobinaemia

A

drugs: sulphonamides, nitrates (including recreational nitrates e.g. amyl nitrite ‘poppers’), dapsone, sodium nitroprusside, primaquine
chemicals: aniline dyes

Normal pO2 but low sats

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21
Q

How to differentiate barters syndrome and Gitleman syndrome

A

Barters and gliteman both have hypokalaemia and normotension BUT

Gliteman will have hypocalcaemia in urine

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22
Q

How to work out Absolute risk reduction

A

Take one group away from other e.g. - 4.1%-3.9%

ARR = 0.2%

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23
Q

What nsaid is mostly likely to cause seizures

A

Mefenamic acid

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24
Q

Commonest valves for IE

A

Mitral and aortic

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25
Q

What penile ulcers are painful and what ones are not (STI related)

A

Painful - herpes and chancroid (haemophilus duceryi)

Painless - syphilis and lymphogranuloma venerum

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26
Q

What does C3 deficiency correlate to

A

Bacterial infection susceptibility

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27
Q

SLE antibodies

A

Anti-smith, anti-DS DNA, Anti-ro, anti-La, ANA

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28
Q

P-ANCA associated conditions

A

Eosinophilic granulomatosis with polyangiitis
Microscopic polyangiitis

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29
Q

What antibody activates B cells

A

IgD

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30
Q

What do macrophages secrete

A

IL1, IL6, TNF alpha

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31
Q

How does cyclophosphamide work

A

Cross links DNA

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32
Q

Lymphogranuloma venereum treatment

A

Drain any fissures and doxycycline

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33
Q

What test is positive in acute syphilis

A

RPR - currently treated or untreated

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34
Q

When to give pred in PJP

A

p02 <9.3pKa

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35
Q

What determines infection risk in HIV

A

Viral load

CD4 not of concern

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36
Q

Antibiotics that inhibit cell wall synthesis

A

Penicillins, carbapenems, vancomycin and cephlasporins

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37
Q

How does aciclovir and ganciclovir work

A

Inhibits viral DNA polymerase

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38
Q

How does azoles and terbinafine work

A

Inhibits ergosterol synthesis

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39
Q

What is a pyogenic liver abscess and how is it treated

A

Polymicrobial liver abscess (staph strep etc) usually from local billary or haematological spread.

Aspiration and abx

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40
Q

What is an amoebic liver abscess and how is it treated

A

Entamoeba histolytica infection with diarrhoea and cysts.

Metronidazole is treatment

(brown anchovy paste)

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41
Q

What is a hydatid liver cyst/abscess

A

Canine tapeworm which hatched eggs in colon and ascend to liver. Can cause peritonitis

Give albendazole or PAIR procedure

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42
Q

How do abx differ between pre-orbital and orbital cellulitis

A

Pre-orbital - co-amox

Orbital - ceftriaxone and metronidazole

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43
Q

Commonest cancer associated with osteomyelitis

A

Squamous cell carcinoma

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44
Q

How to treat ionazid peripheral neuropathy

A

B6 (pyrodoximine)

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45
Q

How does botulism present

A

Bacilius clostridiu, toxin that works down body by blocking ach -

Bulbar palsy, diplopia and ataxia

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46
Q

Leishmaniasis treatment

A

Amphotercin B

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47
Q

Two infections that can cause haemolytic anaemia

A

Mycoplasma and malaria

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48
Q

3 causes of erythrocytosis

A

Polycythemia vera (JAK2 mutation present)
Von-hippel lindau
Renal disease - RCC (EPO secreting tumour)
COPD

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49
Q

Treatment for atrial flutter

A

Cardioversion acutely

Definitive management - radiofrequency ablation of the tricuspid valve isthmus is curative for most patients

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50
Q

When are S3 and S4 heart sounds heard respectively

A

S3– LVF, MR , pregnancy , children

S4 - HOCM, HTN, AS

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51
Q

What ions cause depolarisation, repolarisation and the plateu in cardiac physiology

A

Depolarisation - Na influx
Repolarisation - K eflux
Platu - calcium

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52
Q

What blood test rises first in MIs

A

Myoglobin

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53
Q

What blood test is good to look at reinfarction

A

CK-MB is useful to look for reinfarction as troponin stays elevated for 10 days

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54
Q

the first line investigation for stable chest pain of suspected coronary artery disease aetiology is…

A

Contrast-enhanced CT coronary angiogram

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55
Q

How does histoplasmosis present

A

Histoplasmosis - URTI and mediastinal widening with arthralgia, common in north America

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56
Q

What treatment is given along with PCI in STEMI

A

PCI + aspirin and prasugrel/clopi/tigi

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57
Q

What artery causes anton syndrome

A

Basilar artery

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58
Q

Test for leprosy

A

Skin biopsy

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59
Q

H pylori abx

A

Clari/metronidazole + amox and PPI

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60
Q

How does supraspinatus tendonitis present

A

Pain on initiation of abduction
Improvement in pain on passive movement

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61
Q

Commonest site for radiofrequency ablation

A

Pulmonary veins

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62
Q

What hormones stimulate and reduce hunger

A

Leptin lowers
Gherlin goes

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63
Q

What virus causes oral hairy leukoplakia

A

EBV - Cant scrape off

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64
Q

What does LMWH work on

A

Activates antithrombin and forms a complex that inhibits factor Xa

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65
Q

Difference between webers and benedicts syndroem

A

Webers - CN III palsy,contralateral weakness

Benedicts - CN III palsy, contralateral tremor and ataxia

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66
Q

How does anterior spinal syndrome present

A

Loss of motor, temp and pain but proproception and fine touch is fine

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67
Q

How does an anterior cerebral artery stroke present

A

Contralateral hemiparesis, sensory loss and lower > upper motor symptoms

68
Q

How does an middle cerebral artery stroke present

A

Contralateral hemiparesis, sensory loss and lower < upper motor symptoms, aphasia and hemiopia

69
Q

Lateral pontine syndrome (AICA) and how does it present

A

facial pain and temp loss, deafness and facial paralysis with cerebellar signs

70
Q

How are tonic/atonic seizures managed

A

Males - SV
Females - lamotrigene

71
Q

How are myoclonic seizures management

A

Males - SV
Females - levetiracetam

72
Q

How are generalised seizures managed

A

Males SV
Females levetiracetam or lamotrigine

73
Q

How are focal seizures managed

A

Leviteracetam or lamotrigine

74
Q

Neuromyelitis optica management

A

Rituximab

75
Q

What MND has the BEST prognosis

A

Progressive muscular atrophy
Only LMNL signs

76
Q

Treatment for myasthenia crisis

A

IV IG

77
Q

Tetanus Rx

A

IV Ig and metronidazole

Presents with SPASMS not weakness

78
Q

How long not to drive for if >1 TIA

A

3 months

79
Q

How does anti-Hu paraneoplastic syndrome present

A

Painful sensory neuropathy

80
Q

TIA Rx

A

FIRST 21 DAYS - Aspirin 300mg and clopidogrel 300mg

> 21 DAYS - Clopidogrel 75mg

81
Q

What eye palsy has horizontal diplopia

A

CN VI palsy (abducens)

82
Q

Intranuclear ophthalmoplegia presentation and site

A

Ipsilateral - impaired ADDuction
Contralateral - horizontal nystagmus on ABDuction

Site - medial longitudinal fasiciculus (controls horizontal eye movements)

Vascular issue, tumour or MS

83
Q

FIRST sign of retinitis pigmentosa

A

Night blindness

84
Q

Anterior uevitis management

A

Steroids
Same day eye referral
Analgesia eye drops
Miadratic eye drops/cycloplegics - atropine

85
Q

Acute angle closure glucoma management

A

Pilocarpine drops, timolol, acetazolamide, laser iridotomy

86
Q

Primary open-angle glaucoma management

A

Prostoglandin eye drops (lantoprost)
Timolol and acetazolamide

87
Q

What treatmetn increases AH outflow

A

Prostoglandin eye drops and miotics

88
Q

First line investigation for cushings

A

Overnight dex suppression test

89
Q

ABG result for cushings

A

Metabolic alkalosis

90
Q

Symptoms and treatment for hyperaldosteronism caused by hyperplasia

A

Sy - hypertension, low K, polydipsia, polyuria
Rx - spironolactone

91
Q

What is ridels thyroditiis

A

Chronic woody feeling thyroid. Normal TFTs

Rx if symptomatic with surgery

92
Q

DKA Cx

A

clots, cerebral oedema, ARDS, AKI

93
Q

What causes congenital adrenal hyperplasia and how do you treat it

A

Decreased cortisol synthesis which leads to a rise in ACTH and this excess testosterone and androgens (usually due to PARTIAL 21-hydroxylase deficiency)

Treat with hydrocortisone

94
Q

Medical treatment for gynaecomastia

A

Treat cause
Tamoxifen

95
Q

Treatment for androgen insensitivity syndrome

A

Raise as girl and give oestrogen

96
Q

When can TNF alpha inhibitors NOT be used in treatment plans

A

If MS or NYHA III or IV

97
Q

Poor prognostic factors for psoriatic arthiritis

A

Polyarticular
ESR raised
Anti-CCP

98
Q

The 6As of alk spond

A

apical fibrosis, achillies tendonopathy, aortic regurg, anterior uevitis, amyloidosis, AV node block

99
Q

Rx for alk spond

A

1 - exercise, 2 nsaids, 3 ertacept

100
Q

Drugs that can cause drug induced lupus

A

Hydralazine, isoniazid, phenytoin

101
Q

Antiphospholipid syndrome rx

A

1 - aspirin
2 - warfarin

102
Q

Features of limited cutaneous systemic sclerosis

A

anti-centromere - CREST syndrome and distal rash

103
Q

Features of cutaneous systemic sclerosis

A

SCL-70 and has lung disease with proximal rash

104
Q

Who is polyarteritis nodosa common in

A

Hep B positive patients

105
Q

Behcets disease Rx

A

Topical steroids and culchicine

106
Q

What is affected in ehler danlos syndrome

A

Collagen III

107
Q

Diseases that give koebner phenomenon

A

Posriasis, vitiligo, wars, linchen planus and sclerosis

108
Q

3 causes of linchen planus

A

Hep C
ACEI
BB

109
Q

Bullous pemphigoid management

A

Oral steroids and derm referral

110
Q

Hirsutism Rx

A

Eflornithine

111
Q

Porpyria cutanea tarda deficiency

A

Uroporphyringen decarboxylase

112
Q

Is FH a good or bad prognostic factor for schizophrenia

A

Bad

113
Q

How to gradually reduce benzos

A

reduce by 8th every 2 weeks and switch to diazepam

114
Q

What is othello syndrome

A

Thinks partner is cheating

115
Q

VZV in baby and mum SY+SI

A

Baby -zig-zag skin, LDs, limb hypoplasia
Mum - pneumonitis

116
Q

What to do with BP in acute phase of stroke

A

Do not lower unless being considered for thrombolysis (need to lower bp to less than 185/110mmHg)

117
Q

Management of an acute ischaemic stroke (thrombolysis)

A

CT head - proven ischaemia and not haemorrhagic

Aspirin 300mg

<9hrs - thrombolysis

118
Q

Management of ischaemic stroke (thrombectomy)

A

CT head - proven ischaemia and not haemorrhagic

Aspirin 300mg

2 Scenarios for ischaemic stroke -

1) Thrombectomy within 6hrs of symptom onset WITH IV thrombolysis (if within 4.5hrs)

2) Thrombectomy alone between 6 to 24hrs if salvageable brain tissue via scanning

119
Q

Secondary stroke prevention

A

1 - clopidogrel
2 - Aspirin and dipyridamole

120
Q

Define a cohort study and measurement of use

A

Followed cohort over time to determine an outcome e.g. disease or complication development

Measure relative risk

121
Q

Define case-control study and the mesurement used

A

Patients with a particular condition are identified and matched with controls and data is collecting to find causative agent. Prone to confounding variables

Measure odds ratio

122
Q

Define a cross-sectional study

A

Provide snapshot in time - called prevalence studies

123
Q

Difference in sample sizes needed for superiority trials to non-inferiority trials

A

Superiority - big sample sizes
Non-inferiority - small sample sizes

124
Q

Levels of study evidence

A

Ia - evidence from meta-analysis of randomised controlled trials
Ib - evidence from at least one randomised controlled trial
IIa - evidence from at least one well-designed controlled trial which is not randomised
IIb - evidence from at least one well-designed experimental trial
III - evidence from case, correlation and comparative studies
IV - evidence from a panel of experts

125
Q

How to calculate the coefficient of variation

A

Standard deviation divided by the mean

Measure of distribution where all values are positive

126
Q

Define a type 1 error

A

Incorrectly rejecting the null hypothesis (saying intervention works when it does not)

127
Q

Define type II error

A

Incorrectly accepting the null hypothesis (saying a treatment does not work when it does)

128
Q

What does the rough endoplasmic reticulum do

A

Translation and folding of new proteins

129
Q

What does the smooth endoplasmic reticulum do

A

Steroid and lipid synthesis

130
Q

What does the golgi apparatus do

A

Packages molecules for cell secretion and adds mannose 6 phosphate to them

131
Q

What does the lysosome do

A

Breaks down large proteins and polysaccharides

132
Q

What does the nucleolus do

A

Ribosome production

133
Q

What does the peroxisome do

A

Catabolism of very long chain fatty acids and amino acids - makes hydrogen perioxide

134
Q

What does the proteasome do

A

Degradation of ubiquitin tagged proteins

135
Q

Anti-emetic for pal care bowel obstruction

A

Haloperidol

136
Q

Features of bacilius cereus poisioning

A

Projectile vomiting ususally 1-6hrs after reheated rice

Staph is the same but usually cream-based desserts

137
Q

Commonest SLE Antibody

A

Antinuclear

138
Q

Biggest RF for a successful suicide

A

Previous self harm

139
Q

Types of pelurodesis and when they are used

A

Talc - for malignant pleural effusion

Video-assisted - for pneumothorax (persisitent air leak)

140
Q

Ix of choice for MND

A

EMG

141
Q

SLE management if develop renal disease

A

MMF

142
Q

How to differentiate amoebic liver abscess and hydatid disease on scans

A

Amoebic - reduced attenuation and rim of oedema

Hydatid - peripheral calcification

143
Q

Mannual osmolality calc

A

(NA + K) X2 + glucose + urea

144
Q

First line APCKD treatment

A

ACEI

Tolvaptan added if rapidly progressive

145
Q

Commonest gastroenteritis in schools/nurserys

A

Shigella

Norovirus if short course aka 2 days and vomiting

146
Q

What cells make cck

A

I cells

147
Q

How does irradiated blood products limit GVHD

A

Depleted in T-lymphocytes

148
Q

What is capgras syndrome

A

Thinks family are an imposter

149
Q

ECT indications

A

Refusing to eat and drink
Psychotic depression
Catatonia
Suicidal/delay in SSRI is risky to health

150
Q

Drugs that increase digoxin toxicity

A

Verapamil, nefidipine, quinine

151
Q

Adjustment disorder vs ptsd

A

Rexperiencing event, emotional dysregulation and hyperarousal regarding event NEED to be seen for PTSD

152
Q

How does alcohol affect diabetics

A

Increases insulin release as alcohol redirects blood from exocrine to endocrine pancreas

153
Q

How to determine if schizophrenia or schizo-affective disorder

A

Have intermittent depression in schizoaffective disorder

154
Q

Testicular tumour markers

A

Seminoma and chorocioma - BHCG
Non-seminoma (teratoma) - AFP

155
Q

How to differentiate frontal seizures and parietal lobe seizures

A

Frontal - usually emotional dysregulation then tonic-clonic

Parietal - sensory then jacksonian march

156
Q

UC exacerbations after 72hrs rx

A

Hydrocortisone/pred –> cyclosoprin/infliximab –> surgery

157
Q

Rx for non-alcoholic steatohepatitis (NASH)

A

If fib score <4 - lifestyle measures

If fib score >4 - lifestyle measures and liraglutide

158
Q

Three Ps of MEN1

A

Parathyroid adenoma, pituitary adenoma, peptide tumour (gastrinoma)

159
Q

Valve abnormality with pulmonary hypertension

A

Tricuspid regurg due to backflow of pressure

160
Q

Initial rx for non-falciparum malaria

A

artemether and lumefantrine

161
Q

How to do AAR

A

Always put them into ratios THEN minus from eachother THEN 1/ X

So - The question asks about the number needed to treat to save one life. The ‘event’ is therefore survival.

Experimental (drug A) event rate = 300 / 500 = 0.6
Control (placebo) event rate = 225 / 450 = 0.5

Absolute risk reduction = 0.6 - 0.5 = 0.1
Number needed to treat = 1 / 0.1 = 10

162
Q

Burkitts lymphoma karyotype

A

8 14

163
Q

Alport mode of inheritennce

A

X-linked dominant

164
Q

Dermititis herpetiformis HLA

A

HLA D3

165
Q

When to start dex for meningitis

A

Until the cause of the meningitis is known then dexamethasone should be initiated.
Keep given if confirmed to be pneumococcal (ear infection a RF)

166
Q
A

MRCP (5 decks)

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