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MRCP part 2 > fourth > Flashcards

fourth Flashcards

1
Q

Symptomatic splenomegaly. (evidence grade 1A)
2. Myelofibrosis‐related symptoms that are impinging upon quality of life. (evidence grade 1B)
3. Hepatomegaly and portal hypertension due to myelofibrosis tx ?

A

ruxolitinib

symptomatic splenomegaly and anaemia. First line treatment for this would be hydroxycarbamide

nterferon alpha is used for myelosuppression in myelofibrosis in the presence of thrombocytosis or leucocytosis

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2
Q

cut off FVC for referral to ICU

A

<2L for ICU ref and 1.5L for mech ventilation

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3
Q

liver transplant indication for non paracetamol overdose

A

inr more than 6.5

or
meeting the three , pt more than 100

age <40
inr more than 3.5 pt is more than 50
bilirubin more than 300
ethology drug induced - not through viral hepatitis
duration of jaundice to hepatic encephalopathy >7 days

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4
Q

reduced amplitude but normal conduction velocity is indicative of axonal pathology. Causes of a predominant sensory axonal peripheral neuropathy include

A

diabetes mellitus (commonest cause), B12 deficiency, uraemia, carcinoma (paraneoplastic) and HIV.

GBS,

chronic inflammatory demyelinating polyneuropathy,

amiodarone,

hereditary sensorimotor neuropathies (HSMN) type I,

paraprotein neuropathy,

multiple myeloma

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5
Q

Features of Addison disease

A

The low T4, raised TSH, high calcium, low FSH, low LH, low oestradiol (hypogonadotrophic hypogonadism) are all features of Addisons disease.

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6
Q

Type 4 renal tubular acidosis causes

A

Aldosterone deficiency (hypoaldosteronism): Primary vs. hyporeninaemic
Aldosterone resistance
→ 1.Drugs: Non-steroidal anti-inflammatories, angiotensin converting enzyme inhibitors, angiotensin 2 receptor blockers, eplerenone, spironolactone, trimethoprim, pentamidine
→ 2.Pseudohypoaldosteronism

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7
Q

Drugs causing a peripheral neuropathy

A

amiodarone
isoniazid
vincristine
nitrofurantoin
metronidazole

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8
Q

Drugs causing a peripheral neuropathy

A

amiodarone
isoniazid
vincristine
nitrofurantoin
metronidazole

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9
Q

drug induced lupus include ?

A

minocycline, isoniazid, hydralazine, procainamide

Anti-histone

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10
Q

what antibiotic cover should be avoided in myasthenia gravis?

A

gentamicin

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11
Q

what aesthetic drugs should be avoided in myasthenia gravis ?

A

extremely sensitive to small doses of non-depolarising muscle relaxants such as

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12
Q

treatment for the Lambert-Eaton myasthenic syndrome.

A

3,4-diaminopyridine

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13
Q

psoriasis patient considering conception (both men and women) and systemic therapy cannot be avoided

A

ciclosporin as the first choice

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14
Q

Alkaptonuria - triad of:

A

Dark urine/ black when exposed to air
2. Blue-black pigmented sclera
3. Intervertebral disc calcification

tx
high-dose vitamin C
dietary restriction of phenylalanine and tyrosine

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15
Q

If surgery was to occur in over 12 hours then VTE prophylaxis ?

A

mechanical VTE prophylaxis

low molecular weight heparin should be started, with the last dose given 12 hours before surgery.

If he also had renal failure, then unfractionated heparin should be used and also stopped 12 hours before surgery.

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16
Q

Difference between AIP and porphyria cutanea tarda

A

AIP
Defect in PORPHOBILINOGEN deaminase
Elevated urinary prophobilinogen - normal fecal porphyria
Managed with haematin

Variegate porphyria
autosomal dominant
defect in protoporphyrinogen oxidase
photosensitive blistering rash
abdominal and neurological symptoms
more common in South Africans
Elevated urinary prophobilinogen - high fecal porphyria

PCT
Only restricted to skin
Defect in uroporphyrinogen decarboxylase
Elevated uroporphinogen
pink fluorescence of urine under Wood’s lamp
manage with chloroquine

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17
Q

HIT RECOMMENDATION of Tx

A

Therapeutic danaparoid should be used

Therapeutic dose fondaparinux is an acceptable alternative anticoagulant (although it is unlicensed)

Therapeutic anticoagulation should be continued for 3 months (in those with thrombosis) and 4 weeks (in those without thrombosis)

When transitioning from argatroban to warfarin, the INR should be >4 for 2 days prior to discontinuing argatroban

Warfarin should not be used till platelet count is back in normal range

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18
Q

patients with heart transplant and if patient has bradycardia and shock what is contraindicated ?

A

Atropine

theophyline intravenousely is indicated.

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19
Q

Adverse effects of Tacrolimus:
(TACROLIMUS)

A

T: Tremor
A: Alopecia
C: Cardiovascular (HTN)
R: Renal insufficiency
O: Oncogenic (Skin)
L: Lipid abnormalities (Hyperlipidaemia)
I: Insulin dependent DM
M: Magnesium wasting, Potassium elevation
U: Uric acid elevation
S: Seizure

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20
Q

multifocal motor neuropathy with conduction block (MMNCB)

A

focal arm weakness in the distribution of a named nerve. It usually happens quite suddenly (e.g. over a week)

over several months additional named motor nerves become involved asymmetrically such that MMNCB may eventually look like motor neurone disease (MND) - the principle differential here (specifically the lower motor neurone progressive muscular atrophy form rather than the mixed upper/lower motor neurone ALS form)

nerve conduction studies.
MMNCB shows conduction block. MND does not.

MMNCB is a demyelinating condition, much in the same way Guillain Barre or chronic inflammatory demyelinating polyneuropathy (CIDP) are.

However, in MMNCB this demyelination is in segments of a nerve rather than affecting the whole nerve
So conduction block seen

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21
Q

Chronic inflammatory demyelinating polyneuropathy

A

segmental demyelination of peripheral nerves

features similar to Guillain-Barre syndrome (GBS), with motor features predominating
more insidious onset, over weeks to months - often thought of as the chronic version of GBS
high protein content in the CSF
treatment with steroids and immunosuppressants may have a role (unlike in GBS)

22
Q

tropical spastic paraparesis (TSP) vs syphilus

A

HTLV-1 Associated Myelopathy (HAM)

retrovirus endemic in southern Japan, equatorial Africa and South America.

Transmission occurs through sexual or other intimate contacts, intrauterine, breastfeeding, sharing of needles by drug users, or blood transfusion from infected persons

progressive upper motor neurone symptoms and signs particularly confined to the lower limbs

Vs syphilus
Not demyelinating
Feet slapping gait

lancinating pain- sudden, brief, severe stabs of pain that may affect the limbs, back, or face and that may last for minutes or days

Tabes has absent reflexes

23
Q

multiple daily dose regimens of gentamicin

A

pre-dose (€˜trough’) concentration is high, the interval between doses must be increased.

If the post-dose (€˜peak’) concentration is high, the dose must be decreased

24
Q

Loiasis presentation ?

A

pruritus
urticaria
Calabar swellings: transient, non-erythematous, hot swelling of soft-tissue around joints
‘eye worm’ - the dramatic presentation of subconjunctival migration of the adult worm.

25
complication of loiasis compared to other microfilarial infections Onchocerciasis and Lymphatic Filariasis
associated with encephalopathy following treatment with either Ivermectin or DEC. This occurs due to the death of vast numbers of blood microfilaria. Both of these drugs are contraindicated if loa loa microfilaraemia exceeds 2500 mf/ml
26
leprosy presentation ?
saddle nose deformity (relapsing polychondritis, cocaine abuse, congenital syphilis, lepromatous leprosy and trauma. ) non-painful lumps esp medical epicondyle joint, renal and conjunctival involement indicate a type 2 reaction which occur in patients with lepromatous leprosy (usually following treatment) if treated with steroids patients neurological symptoms worsen yet the skin disease improves on starting steroids
27
leprosy tx ?
multibacillary leprosy 6 lesions - triple therapy with rifampicin, dapsone and clofazimine (RDC) for 12 months. For paucibacillary leprosy (5 or less lesions) you should give rifampicin and dapsone (RD) for 6 months.
28
leprosy dx ?
Diagnosis is made by demonstrating acid fast bacilli within a cutaneous nerve on microscopy
29
fentanyl and mss conversion
fentanyl 75 patch = 180mg daily intake of morphine salt fentanyl 100patch = 240mg daily morphine salt intake. FROM MST TO FENTANYL = 2.4
30
Seizure inducers ?
include fentanyl, mefenamic acid, and tramadol (among others). amitriptyline, aminophylline, theophylline isotretinoin and haloperidol alcohol, cocaine, amphetamines ciprofloxacin, levofloxacin bupropion methylphenidate (used in ADHD) mefenamic acid
31
Prophylaxis for infective endocarditis ?
Prosthetic cardiac valve or prosthetic material used for cardiac valve repair Previous infective endocarditis Cardiac transplantation with the subsequent development of cardiac valvulopathy Unrepaired cyanotic defects, including palliative shunts and conduits Completely repaired defects with prosthetic material or devices whether placed by surgery or catheter intervention, during the first 6 months after the procedure (after which the prosthetic material is likely to have been endothelialised) Repaired defects with residual defects at or adjacent to the site of a prosthetic patch or device (which inhibit endothelialisation)
32
confirmed diagnosis of a superficial vein thrombosis tx ?
anti-embolism stockings and prophylactic doses of low molecular weight heparin (LMWH) for 30 days or fondaparinux for 45 days. In cases where LMWH is contraindicated, 8-12 days of oral non-steroidal anti-inflammatory drugs
33
amyl nitrate toxicit
blurred vision, xanthopsia and haemoptysis
34
gamma hydroxybutyric acid (GHB) toxicity
CNS and respiratory depression, hypersalivation, bradycardia and hypotension
35
All NSCLC with stage I or II disease should undergo
resection surgery stage III disease generally is focused on chemotherapy FEV1 >2l/s for pneumonectomy and 1.5l/s for lobectomy
36
Aortic stenosis mx ?
surgical aortic valve replacement (SAVR) then a bioprosthetic valve would be preferred over a mechanical valve, freeing the patient from the need for lifelong anticoagulation Transcatheter aortic valve insertion (TAVI) - unfit for SAVR due to high predicted mortality. transfemoral TAVI suitable for patients with a low or intermediate risk associated with SAVR Transfemoral TAVI is increasingly favoured over SAVR as patient age increases transapical TAVI are inferior to SAVR, so this intervention is only appropriate for individuals with an unacceptably high surgical risk
37
extensor plantars with absent ankle reflexes
MND, Friedrich's ataxia, subacute combined degeneration of the cord or tertiary syphilis
38
When to Offer revascularisation in angina
stable coronary artery disease and ischaemia in > 10 % of the left ventricle. Also, the patient's age and lack of co-morbidities
39
Lupus nephritis tx
INDUCE remission both cyclophosphamide and mycophenolate + along with glucocorticoids can be used with the same efficacy but with the former having more side effects ( can cause permanent infertility in both male and female). dealing with 32 year old female so we should chose mycophenolate. 2. Maintenance of remission is recommended with either mycophenolate or azathioprine. Cyclophosphamide is not recommended for maintenance therapy
40
Increasing tidal vol in mech ventilation
Increase the RR and cause resp alkalosis
41
renal biopsy contra ?
polycystic kidneys, obstruction of the urinary tract, or hydronephrosis
42
synthetic cannabinoid toxicity
seizure, myoclonus, mydriasis, hypertension, acute kidney injury and hypokalaemia
43
toluene toxicity
irritation to the eyes, nose and respiratory tract
44
Amyl nitrate toxicity
hypotension blurred vision, xanthopsia and haemoptysis
45
gamma hydroxybutyric acid (GHB) toxicity
CNS and respiratory depression, hypersalivation, bradycardia and hypotension
46
NSCLC Management
Lobectomy (with hilar and mediastinal lymph node resection/sampling) is first-line treatment for those with stage I or II cancer Radiotherapy: Is first-line for those with stage I-III disease who are not suitable for surgery. This treatment is given with curative intent. Chemotherapy: Is offered to those with stage III or IV disease to improve survival and quality of life. ===== Adjuvant chemotherapy should be offered to patients who have undergone a complete resection Adjuvant radiotherapy is offered to patients who have had a incomplete resection of their tumour All patients with stage I-III disease who are not suitable for surgery should be considered for chemoradiotherapy
47
chronic respiratory conditions including asthma requiring frequent use of oral steroids should be offered
23-valent unconjugated pneumococcal polysaccharide vaccine - 5 yearly and the influenza vaccine - annual ======== Re-vaccination is not recommended for most people. However, for those who have asplenia, splenic dysfunction, or chronic kidney disease, re-vaccination is recommended every 5 years.
48
Long QT syndromes
Long QT1: adrenergic surge due to intense physical activity such as swimming Long QT2: adrenergic surge due to intense emotion such as excitement or fear Long QT3: death during sleep Long QT syndromes can result in sudden cardiac death when patients are exposed to an adrenergic surge which can put the patient into VF or VT.
49
cavernous sinus
oculomotor nerve with parasympathetic involvement = complete ptosis pupil is unreactive and larger in diameter involvement of the trochlear nerve vertical eye movements and loss of adduction in his left eye and also the first and second branch of the trigeminal nerve, hence sparing of his left chin as supplied by the mandibular branch of the trigeminal nerve.
50
paraneoplastic syndromes antibodies and site of production
NMDA receptor antibodies = ovarian cancer limbic encephalitis typically presents with a subacute development of memory impairment, confusion, and alteration of consciousness, often accompanied by seizures and temporal lobe signal change on MRI. Voltage-gated potassium channel antibodies = Thymoma or small cell lung cancer Anti-Hu antibodies = Small cell lung cancer Anti-GAD = Thymoma anti-Ma2 antibodies = Germ-cell tumours of testis, non-small cell lung cancer
51
TIA follow up
Crescendo TIA - one more episode Urgent review or admission Suspected TIA within 7 days - urgent assessment within 24 hours Suspected TIA occurred more than 7 days - assessment by specialist within 7 days

MRCP part 2 (6 decks)

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