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MRCP > Final deck 2 > Flashcards

Final deck 2 Flashcards

1
Q

Treatment given before carcinoid surgery

A

Octeride - somatostatin anologue as it blocks precursor of sertraline

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2
Q

What is neuralgic amytrophy

A

Basically brachial neuritis - intense paina round shoulder then patchy neuropathy for a few weeks afterwards. Usually mild sensory features but LMNL signs with a wining scapula
Can be due to vaccines, childbirth, trauma

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3
Q

How to differentiate left and right axial myomas

A

Left - TIA and strokes
Right - PEs and pulmonary HT

General - weight loss, malaise, night sweats, joint pains

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4
Q

Features of type 1 myotonic dtrophy

A

4 Ds

distal weakness initially
autosomal dominant
diabetes
dysarthria

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5
Q

How to work out standard error of mean

A

Standard error of the mean = standard deviation / square root (number of patients)

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6
Q

Brachial neuritis is characterized by…

A

acute onset unilateral severe pain followed by shoulder and scapular weakness several days later

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7
Q

Commonest cause of osteonecrosis of the jaw

A

IV Bisphosphonates for cancer

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8
Q

WPW Acute treatment

A

Flecanide

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9
Q

Pain in neck and specific hand muscle weakness, whats the diagnosis

A

Cervical rib

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10
Q

Factor V leiden deficiancy treatmetn

A

DOAC

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11
Q

Features of ariboflavinosis

A

B2 (Riboflavin) deficiency - normochromic anaemia, glosittis, angular stomatitis, photosensitivity

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12
Q

How does copper deficiency present

A

Menkes disease - blue sclera, osteoporosis, steel coloured hair

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13
Q

Most effective lipid lowering drug

A

Fibrates

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14
Q

How do fibrates work

A

Increase liver enzymes whihc metabolise LDLs

Prefered drug used in raised triglycerides

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15
Q

How does ezetimbie work

A

Inhibits cholestrol gut absorption

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16
Q

Porphyria genetic inheritance

A

Autosomal dominant with incomplete penetrance

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17
Q

Porphyria cutanea tarda presentation

A

Photosensitive rash with bullae and hep C/Alcohol

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18
Q

Trinucleotide repeat disorders

A

Fragile X
Friedrichs ataxia
Huntingtons
Myotonic dystrophy
Spinocerebellar ataxia

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19
Q

Features of cowdens syndrome

A

PTEN gene

Hamartomas in breast and thyroid

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20
Q

Drugs that cause hepatitis

A

Paracetamol, aspirin, valproate, NSAIDs, phenytoin, alcohol, statins, ioniazid

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21
Q

Drugs that cause cholestasis

A

Co-amox, fluclox, clarithromycin, carbimazole, anabolic steroids, rifampacin, chlorpromazine

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22
Q

P450 Inducers (reduce drug affect)

A

SCRAP GPS

Sulfonlyureas
Carbamazepine
Rifampicin
Alcohol (chronic)
Phenobarbital

Grisofacin
Phenytoin
St Johns wart

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23
Q

Drugs for acute intermittent porphyria triggers

A

ABCDS

Alcohol, antihistamines, antidepressants
Barbituates
Cephlasporins, contraception
Diuretics
Sulfonlyureas

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24
Q

SSRI antedote

A

Cryptoheptadine

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25
Q

Define the hawthorne affect

A

Participants change behaviour when knows it is being studied.

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26
Q

What is a type 1 error (alpha)

A

Null hypothesis rejected when true (false positive)

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27
Q

What is a type 2 error (beta)

A

Null hypothesis accepted when false (false negative)

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28
Q

What does dabigatran work on

A

Direct thrombin inhibitorW

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29
Q

What is the reversal agent for dabigatran

A

Idarucizumab

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30
Q

What is essential thrombocythaemia and what is seen on bone marrow biopsy

A

Platelet count >450 and JAK2 mutation present
Biopsy has staghorn megakaryocytes

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31
Q

CML treatment

A

Imatinib

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32
Q

CLL Treatment and blood film finding

A

Fludarabine, cyclophosphamide, rituximab

Blood film finding - smear cells

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33
Q

GS investigation for CLL

A

Immunophenotyping

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34
Q

GS investigation for CML

A

FISH assay

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35
Q

Non-hodgkins lymphoma management

A

R-CHOP

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36
Q

Hodgkins lymphoma management

A

ABVD

Has reed stenberg cells

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37
Q

B and T cell lymphoma tumour biomarkers

A

B cell - CD20
T cell - CD3

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38
Q

How does doxorubicin and epirubicin work

A

Inhibit topoismerase II to prevent DNA/RNA synthesis

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39
Q

How do paclitazel and docetaxel work

A

Distrubts microtubules (neuropathy)

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40
Q

How does etoposide and arintoecan work

A

Uncoils DNA

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41
Q

How does vincritstine and vinblastin work

A

Microtbule distruption

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42
Q

What does alematuzumab work on

A

Anti-CD52 - CLL

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43
Q

TLS Bloods

A

High potassium, low calcium, high urate, low phosphate

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44
Q

Morphine and diamorphine ratios

A

2/3 diamorphine to 1 morphine

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45
Q

First line treatment for agitation

A

Halopiradol

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46
Q

First and second line for hiccups

A

Chlorpromazine –> haloperidol

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47
Q

Length of time for cancer related DVT/PE Rx

A

3 months

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48
Q

Indications for BIPAP

A

Worsening type 1 RF
COPD with resp acidosis of <7.35 BUT more than 7.25
Cardiogenic PO unresponsive to CPAP
Intubation weaning

Remember cant give if confused, vomiting, haemodynamically unstable, burns, untreated pneumothorax.

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49
Q

Pulmonary vasculitis management

A

Acute - pred + cyclophosphamide

Remission - azathioprine

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50
Q

What patients get a chest drain for pneumothorax

A

Over 50 and smokes
Underlying lung disease
Haemothorax
Bilateral
Hypoxia

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51
Q

What does the A waveform correlate to

A

Atrial contraction

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52
Q

What does the C waveform correlate to

A

Tricuspid valve closure

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53
Q

What does the X descent correlate to

A

Fall of atrial pressure during ventricular systole

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54
Q

What does the V waveform correlate to

A

Passive filling of Right atria

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55
Q

What does the Y descent correlate to

A

Tricuspid valve opening

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56
Q

What causes large A waves

A

Tricuspid stenosis or P HT

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57
Q

What causes cannon A waves

A

Heart block

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58
Q

What causes absent A waves

A

AF

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59
Q

What causes large V waves

A

Tricuspid regurg

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60
Q

What MI responds well to IVT

A

Posterior MIs

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61
Q

Complication of BB

A

Raised BMs

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62
Q

Rheumatic fever presentation

A

Arthalgia, fever, rash, prolonged PR, HB, Erythema marginatum (looks like ringworm)

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63
Q

Hypertrophic Obstructive cardiomyopathy management

A

ABCD -
Amiodarone, beta blocker/verapamil, cardioverter defib, dual chamber pacemaker

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64
Q

Acute pericarditis ECG findings

A

ECG - PR depression (more specific) and saddle ST elevation

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65
Q

Myocarditis causes (infection)

A

Diptheria
HIV
Coxsackie
Toxopmasmosis
Trypanomiosis
Lymes disease

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66
Q

Difference between mobitz type 1 and type 2

A

Type 1 - progressive PR then dropped beat
Type 2 - same PR then dropped beat

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67
Q

How to differentiate atrial flutter from atrial tachy

A

Atrial tachy has isoelectric baseline

A flutter has 300BPM usually

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68
Q

Brugada syndrome ECG findings

A

ST elevation in lead 1 and V1-V3 TWI and RBBB

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69
Q

The three cyanotic birth cardiac defects

A

Pulmonary stenosis
Tetraology of fallot (months old presentation)
TP Great arteries (Presents at birth)

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70
Q

Second line Rx for eosinophilic oesophagitis

A

PPI and fluticasone oral

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71
Q

Achalasia treatment

A

1- pneumatic dilatation
2 - Heller cardiomyotomy
3 - Botox injection (good if poor surgical candidate)

72
Q

H. Pylori eradication test

A

Urea breath test

73
Q

Test for zollinger ellison syndrome

A

FASTING plasma gastrin level

74
Q

Features of Crohns disease on biopsy

A

Goblet cells, cobblestone and full thickness, NO blood/mucus

75
Q

Features of UC on biopsy

A

No cobblestone or goblet cells, superficial thickness with blood and mucus

76
Q

Crohns remission Rx

A

Azathioprine - 1
Methotrexate - 2

77
Q

Causes of low SAAG and high SAAG (>11g/L)

A

Low - TB, Pancreatitis, Nephrotic syndrome

High - Portal hypertension - cirrhosis, HCC, Budd-chairi, HF

78
Q

Gram negative SBP, whats the cause

A

TB

79
Q

Rx for SBP

A

IV cefotaximine and albumin

80
Q

Hepatorenal syndrome rx

A

Terlepressin and albumin

Transplant

81
Q

Abx choice for upper GI bleed

A

Ciprofloxacin

82
Q

Hep C rx

A

Protease inhibitors and ribavarin

83
Q

HLA of autoimmune hepatitis

A

HLA3 and HLA4

84
Q

Wilsons disease gene

A

ATP7B gene on chromosome 13

85
Q

When is lipase good in pancreatitis

A

Late presentations

86
Q

CT abdo - double duct sign, whats the diagnosis

A

Pancreatic cancer

87
Q

Causes of a normal anion gap

A

ABCD

Acetazolamide
Bicarb loss (renal tubular acidosis)
Chloride excess (NaCl) - hyperchloremic metabolic acidosis.
Diarrhoea

88
Q

What is cystinuria and its features

A

Defect in membrane transport of cystine causing renal stones recurrently

89
Q

What is hartnup disease

A

Tryptophan deficiency - pellegra with ataxia

90
Q

Minimal change biopsy results

A

Usually nil/ reduced podocytes

91
Q

Focal segmental GN causes

A

HIV
Heroin
Alport syndrome

Sclerosis and hyalinosis on biopsy

92
Q

Membranous nephropathy causes

A

SLE, RA, Sarcoidosis, crohns, hep B and C, NSAIDs, CANCER

93
Q

Membranous nephropathy results on biopsy

A

Thickened spike and dome deposits

94
Q

Two types of mesangicapillary/mesangioproliferative GN

A

1 - Hep C and cryptoglobulinaemia (Low C4)

2 - Lipodystrophy from face and low C3

95
Q

Nodules associated with Diabetic nephropathy

A

Kimmstel wilson nodules

96
Q

Amyloidosis results on biopsy

A

Amorphic deposits with congo red stain

97
Q

Valve abnormality with ADPCKD

A

MV prolapse - midsystolic and click

98
Q

Second line for CKD associated HT

A

ACE is first

Second is furosemide as helps keep K down

99
Q

Second line for CKD associated proteinuria

A

First is acei
Second is SLGT inhibitors

100
Q

Name two calcineurin inhibitors

A

Tacrolimus and cyclosporin

101
Q

3rd line prostate Rx

A

Finasteride - 1
Tamsulosin - 2
Tolteradine (anticholingergic) - 3
TURP - 4

102
Q

Neuroendocrine features or RCC

A

Raised EPO
Raised PTH
Raised ACTH

103
Q

What autoimmune hepatitis subtype is related to antismooth muscle abs

A

Type 1

Type 2 is more common in kids and has Anti- liver kidney abs

104
Q

What kind of chest bacteria produces halitosis

A

Anerobes

105
Q

Fabry disease is caused by a deficiency of what

A

alpha-galactosidase A

106
Q

How to differentiate fatty liver of pregnancy and cholestasis of pregnancy

A

Patients unwell in FLoP with AST and ALT higher than ALP

well in cholestasis of pregnancy and higher ALP than AST and ALT

107
Q

Bitemporal hemiopia quadrant defects

A

upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour

lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

108
Q

What disease is screened before starting rituximab

A

Hep B

109
Q

cANCA and pANCA targets

A

MPO = pANCA
PR3 = cANCA.

110
Q

Gastrinoma tumour site

A

First part of duodeunum

111
Q

What does a full house immunology mean on renal biopsy

A

Have IgA, IgG, IgM, C3 and C4 and associated with SLE

112
Q

How does EBV present in adults

A

Anaemia, lymphocytosis, RUQ pain, hepatosplenomgaly, fever and malaise.

IgG negative as never had it before so presents as above

113
Q

LMWH Cut off for kidneys

A

Lower dose if eGFR <30

114
Q

Glasgow criteria for pancreatitis

A

PaO2 <8kPa
Age >55
Neutorphilia >15
Calcium <2mmol/l
Renal function (Urea >16)
Eenzymes AST >200 and LDH 600
Albumin <30
Sugar - glucose >10

115
Q

Amyloidosis subtypes

A

AA - chronic inflammation
AL - Myeloma
Beta2 immunoglobulin - renal dialysis

116
Q

What does alemtuzumab work on

A

Anti-CD52

117
Q

What does abciximab work on

A

glycoprotein IIb/IIIa receptor antagonist

118
Q

What does rituximab work on

A

Anti-CD20

119
Q

What does cetuximab work on

A

(epidermal growth factor receptor antagonist): used in metastatic colorectal cancer and head and neck cancer

120
Q

Features of horners syndrome

A

miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)

121
Q

How to remember the different subtypes of Horners syndrome

A

Central (the S’s) anhidrosis of face, arm and trunk - stroke, syringomelia, MS, EncephalitiS

Pre-ganglionic lesions (the Ts) anhidrosis of the face- PancoasT Tumour, Thyroidectomy, Trauma, cervical rib

Post-ganglionic lesions (The Cs) No anhidrosis - carotid artery dissection, carotid aneurysm, cavernous sinus thrombosis, cluster headache

122
Q

How does central Horners syndrome present and its causes

A

Anhidrosis of the face, arm and trunk

Stroke
Syringomyelia
Multiple sclerosis
Tumour
Encephalitis

123
Q

How does Pre-ganglionic lesions Horners syndrome present and its causes

A

Anhidrosis of the face

Pancoast’s tumour
Thyroidectomy
Trauma
Cervical rib

124
Q

How does Post-ganglionic lesions lesions Horners syndrome present and its causes

A

No anhidrosis

Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache

125
Q

Where does foundaparinus work

A

Indirect Xa inhibitor

Give factor 7active as reversal

126
Q

Where do DOACs except dibigatran work

A

Direct Xa inhibitor

127
Q

Where does dabigatran wrok

A

Direct thrombin inhibitor

128
Q

What drug class and drug can prolong levodopa effectiveness

A

COMT inhibitors - entacapone

129
Q

What can trigger liddles syndrome

A

Stress
Conns cant be triggered by stress

130
Q

Central bronchiectasis with difficult to control asthma, whats the diagnosis

A

allergic bronchopulmonary aspergilliosis

131
Q

Characteristic pattern of hair loss for alopecia artera

A

Exclimiation pattern

Give intralesional steroids

132
Q

Guidelines for carotid endartectomy

A

Carotid endarterectomy is recommend if the patient has suffered a stroke or TIA if the stenosis > 50%

133
Q

What is the function of bevecuzimab

A

Anti-VEGF

134
Q

PE presentation and in labour or within 2 days of labour, whats the likely diagnosis

A

Amniotic fluid embolism

135
Q

Abx for listeria meningitis

A

Ampicillin

136
Q

Reason for drop in GCS post-stroke

A

Cerebral stroke - cerebral oedema
Brainstem stroke - compression of 4th ventricle

137
Q

When to use mann whitney test

A

Mann-Whitney compares non-parametric data which is unpaired

138
Q

When to use chi-squared

A

Chi-squared is used when comparing percentages of non-parametric data.

139
Q

Prosthetic heart valves - antithrombotic therapy for bioprosthetic and mechanical

A

bioprosthetic: aspirin
mechanical: warfarin + aspirin

140
Q

What is systemic mastocytosis and how does it present

A

Caused by neoplastic proliferation of mast cells

urticaria pigmentosa - produces a wheal on rubbing (Darier’s sign)
flushing
abdominal pain
monocytosis on the blood film

141
Q

What is mcardle disease

A

Repeated cramping, rhabdomyolysis and myoglobinuria after short bouts of exercise can point towards McArdle’s disease

second wind phenomenon
occurs when patients experience an improvement in exercise tolerance after a brief rest or reduction in intensity

142
Q

Features of a second heart sound

A

loud: hypertension
soft: AS
fixed split: ASD
reversed split: LBBB

143
Q

Best Rx for acute AF in young people (aka no structural heart disease etc)

A

Flecanide

144
Q

How to tell difference between Barters and Glietman

A

Both - normotension, low K

Glietman - low urinary calcium
Barters - normal urinary calcium

145
Q

IBD Arthropathy rx

A

sulfazalazine

146
Q

What drug often inhibits clopidogrel and how does it do that

A

Omeprazole - CYP219 inhibitor

147
Q

Anorexia cut off for BMI

A

17.5

148
Q

4th line COPD treatment

A

Rofmlimulast

149
Q

Age cut off for males with UTI for cystourethrogrpahy

A

16

150
Q

Where does bendroflumathiazide work

A

DCT

151
Q

Safe DMARDs in pregnancy

A

Sulfasalazine
Hydroxychloroquine
Azathioprine

152
Q

Atrial septal defect murmur

A

Atrial septal defect - ejection systolic murmur louder on inspiration

153
Q

Modes of inheritence for certain conditions

A

Autosomal recessive conditions are ‘metabolic’ - exceptions: inherited ataxias

Autosomal dominant conditions are ‘structural’ - exceptions: Gilbert’s, hyperlipidaemia type II

154
Q

Pathophysiology of stress and urge incontinence

A

Stress - uterine prolapse
Urge - detrusor oceractivty

155
Q

What is schizoid personality disorder

A

Wants to be left alone and indifferent to praise

156
Q

What is schizotypal personality disorder

A

Unusual beliefs and magical thinking

157
Q

Burkitts lymphoma translocation

A

8:14

11:18 is a MALT lymphoma

158
Q

Commonest bug in SBP

A

E coli

159
Q

Difference between beta thallassemia and beta thallassemia intermitia

A

Usually have splenomegaly with intermitia but nothing with trait

160
Q

Hyperaldosteronism on the blood gas

A

Hypokalaemic metabolic acidosos

161
Q

Leptospirosis GS test

A

Microscopic aggulation test

162
Q

Commonest type of MODY

A

3 - commonest, picked up in early 20s

2 - Asymptomatic

163
Q

Triptan drug class

A

5-HT1 receptors

164
Q

What is hyporinaemic hypoaldosteronism

A

Essentially presents like liddles disease (low K and bicarb with HT) but in middle aged people on max ACEI/ARB doses

165
Q

Examples of dopamine agonists and main side effects

A

Ropinorole and Rotigotine

Excessive gambling etc

166
Q

First line for HT management in those that take lithium

A

CCB

167
Q

What happens to hepicidin in CKD

A

rises (acute phase reactant) - causes anaemia

168
Q

Familial adenomatyosis polyposis (APC) gene management

A

Total protolectomy with ileal pouch anal anastomaosis

169
Q

Treatment to prevent further calcium renal stones

A

Thiazide like diuretics

170
Q

What morphine metabolite causes resp depression

A

Morphine-6-glucoronide

171
Q

How to tell difference between bacterial contamination and TRALI on presentation

A

TRALI is approx 6 hrs later after transfusion started

Bacterial contamination is 10-20mins later. Can get pulmonary oedema with it.

172
Q

Steroid replacement dose for adrenal insufficency

A

4mg dex or 20 hydrocortisone

173
Q

How to tell difference between SUNCT and cluster headaches

A

SUNCT - very short minute or 2 bursts
Cluster headaches - hour episodes

174
Q

Test to diagnose NPH

A

CT and then LP to reduce pressure and show improvement of symptoms. If improvement - shunt

175
Q
A

MRCP (5 decks)

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