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MRCP - Part 1 > Geries > Flashcards

Geries Flashcards

1
Q

Presentation of digoxin toxicity

A

Disorientation
Vomiting
Mental confusion
Amnesia
Depression
Yellow visual field discolouration (xanthopsia)

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2
Q

What are lewy bodies made up of?

A

Alpha synuclein

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3
Q

When is ECT recommended

A

Life threatning depressive stupor
- especially when refusing to eat or drink
Treatment resistant depression

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4
Q

WHat does paralysis of the deltoid muscle cause

A

Weakness of shoulder abduction, particularly after 30 degrees of abduction (supraspinatus assists in the first 30)
Weakness of drawing arm forward and internal rotation

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5
Q

What causes osteomalacia

A

Lack or impaired metabolism of Vitamin D

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6
Q

What kind of drug is rifampicin

A

cytochrome p450 enzyme inducer

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7
Q

Interaction of rifampicin and warfarin

A

Increased metabolism of warfarin and a fall in INR

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8
Q

Drugs that can reduce INR when on warfarin

A

Rifampicin
Phenytoin
Carbamazepine
St johns wort

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9
Q

Drugs that can increase INR when on warfarin

A

Erythromycin
Metronidazole
Cipro
Cimetidine
Allopurinol

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10
Q

Triad of NPH

A

Gait disturbance
Incontinence
Cognitive impairment

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11
Q

CT features of NPH

A

Ventricular enlargement

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12
Q

Treatment of NPH

A

Large volume CSF removal (LP or lumbar drain)
If benefits from above - VP shunt placement

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13
Q

Type of gait in NPH vs PD

A

NPH - broad based shuffling gait
PD - narrow based shuffling gait

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14
Q

When does senile degenetative AS occur

A

Progressive calcification of the valve leaflets in response to long standing haemodynamic stress

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15
Q

What can cause subacute combined degeneration of the spinal cord

A

Vitamin B12 deficiency

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16
Q

Features of walderstroms macroglobulinaemia

A

Hepatosplenomegaly
Anaemia
Thrombocytopenia
Raised plasma viscosiity
Raised IgM

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17
Q

Immeediate treatment of increased plasma viscosity of walderstoms macroglobulinaemia

A

Urgent plasmapheresis

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18
Q

Treatment of mild - mod alzheimers

A

Acetylcholinesterase inhibiting drugs e.g.
- donepezil
- rivastigmine
- galantime

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19
Q

Treatment of severe alzheimers

A

Memantime

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20
Q

MMSE score for someone with severe alzheimers

A

< 10 / 30

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21
Q

Why does digoxin take a while to work

A

High degree of protein binding

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22
Q

Indicators of DIC

A

Hx of malignancy
Thrombocytopenia
Prolonged PT, APTT
Reduced fibrinogen levels

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23
Q

What do brainstem strokes cause

A

Contralateral weakness
Ipsilateral sympathetic pathway (horners syndrome)
Ipsilateral hypoglossal nerve causing tongue weakness on the affected side
Medial longitudinal fasciculus causing nystagmus as part of an ipsilateral internuclear opthalmoplegia
Body sensory loss on contralteral side
Facial sensory loss on ipsilateral side

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24
Q

Presentation of cerebellar strokes

A

Ipsilateral weakness
DANISH
- dysdiadokokinesis
- ataxia
- nystagmus
- intention tremor
- slurred speech
- hypotonia

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25
Q

Neuro exam of myasthenia gravis

A

Proximal muscle weakness
Ptosis
No muscle wasting or fasiculation
Sensation normal
Tone normal
Reflexes normal

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26
Q

Antibodies of myasthenia gravis

A

anti-acetylcholine receptor Abs

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27
Q

Treatment of myasthenia gravis

A

Acetylcholinesterase inhibitors
Oral corticosteriods

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28
Q

When is Lambert Eatson syndrome seen

A

Bronchial carcinoma

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29
Q

Neurology of Lambert Eaton syndrome

A

Proximal muscle weakness
May improve initially on exercise
Lessens as exercise is sustained
Reflexes reduced or absent

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30
Q

Presentation of GBS

A

Ascending pattern of progressive symmetrical weakness, starting in lower extremeties
Neuropathic pain may develop
Reflexes reduced or absent

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31
Q

Why does TMP exacerbate poor renal function

A

Compettive inhibition of creatinine secretion

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32
Q

Diagnosis for amyloidosis on histology post biopsy

A

Congo red staining

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33
Q

Who should you not give haloperidol to

A

PD patients

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34
Q

What can risperdione worsen

A

PD symptoms

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35
Q

Treatment of VT with no adverse features

A

Amiodarone

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36
Q

Presentation of SCC

A

Ulcerated nodular lesion
Surrounding paraesthesia
Hyperkeratotsis

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37
Q

What can SCC evolve from

A

actinic keratosis

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38
Q

What causes melanosis coli

A

Long term laxative abuse
Over time this leads to pigment deposition in the mucosa

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39
Q

What area of the brain do the cranial nerves pass through

A

Jugular foramen

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40
Q

Lesions that affect brocas area result in what

A

Expressive aphasia

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41
Q

Features of PSP (progressive supranuclear palsy)

A

Falls seen very shortly after onset of Sx
Symmetrical (proximal > distal) rigidity
Poor response to levodopa
Dysphagia
Decreased verbal fluency
Supranuclear gaze palsy (loss of vertical gaze)

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42
Q

Is autonomic dysfunction common or uncommon in PSP

A

Uncommon

43
Q

Features of MSA (multi-system atrophy)

A

Cerebellar signs
Autonomic dysfunction

44
Q

Features of corticobasal degeneration

A

Asymmetrical signs
Predominantlely presents with rigidity
Alien limb syndrome (unable to control movements of an isolated limb) leading to a sensation that the limb is foreign
Apraxia
Aphasia as the disease progresses

45
Q

Features of lewy body dementia

A

Fluctuating confusion/onset of dementia
Persistent visual hallucinations
Spontaenous parkinsonism
REM sleep disorder
Unexplained syncope

46
Q

Presentation of primary polycythaemia

A

Headaches
Itching

47
Q

Mutation of primary polycythaemia

A

JAK2 gene

48
Q

Blood results of primary polycythaemia

A

Raised Hb
Raised hct
Raised WCC
Raised platelets
Erythropoietin low

49
Q

Treatment of bipolar disorder

A
  1. Lithium
  2. Add valproate
50
Q

Investigation of a chronic leukaemia

A

Immunophenotyping / flow cytometry

51
Q

Pathologically, what does tonsillar herniation cause

A

Increase in BP
Fall in HR

52
Q

What indicates a restrictive filling pattern (heart)

A

Dilated atria

53
Q

What can be seen in the myocardium to indicate amyloid?

A

Speckled appearance

54
Q

What forms the posterior cerebral arteries

A

Basilar artery

55
Q

What do the posterior cerebral arteries supply

A

Occipital lobe

56
Q

What causes anton syndrome

A

Bilateral occipital lobe infarcts

57
Q

What kind of meningitis are the elderly at increased risk of

A

Listeria meningitis

58
Q

Who should be covered for listeria meningitis and what drug should be added to ceftriaxone?

A

> 60 and immunosuppressed
Amoxicillin

59
Q

Anti-emetic of choice in PD

A

Ondansetron

60
Q

What does the nerve root L1/2 supply

A

Sensory to anterior groin
Motor supply to hip flexors

61
Q

If the L4 nerve root is involved in damage, what would you expect to see

A

Sensory disturbance of the anterior thigh

62
Q

If L4/5 was affecred, what would you expect to see

A

Altered sensation in the lower leg

63
Q

If L5/S1 nerve root was affected, what would you expect to see

A

Altered sensation below the knee and over the foot
Foot drop

64
Q

2/3rds of leg ulcers are due to what

A

Chronic venous insufficiency

65
Q

If ABPIs are statisfactory, what is the management of venous ulcers

A

Compression

66
Q

Genetics of HD

A

AD
Huntington gene on chromosome 4
CAG repeat expansion

67
Q

Pathological findings in HD

A

Neurodegeneration in the cortex and striatum, especially in the caudate nucleus

68
Q

What is characteristic of HD

A

Chorea (random dancing movements flitting from one body part to another)
Can also have
- parkinsonsim
- frontal subcotical cognitive impairment
- behavioural disturbance
- slow, saccardic eye movements
- depression
- dementia

69
Q

Example of management of chorea in HD

A

Anti-dopaminergic agents such as tetrabenazine

70
Q

Main role of the hippocampus

A

Memory
Spatial navagation

71
Q

Lesions affecting the substantia nigra would result in what

A

Parkinsonism

72
Q

Pathology of LBD

A

Accumulation of aggregated form of alpha-synuclein into lewy bodies with vulnerable neurons

73
Q

Treatment of acitiinic keratosis

A

Topical 5-FU

74
Q

Half life of amiodarone

A

25-30 days
Cessation may take several months for the drug concentration has fallen to an insiginifant level

75
Q

Mechanism of action of allopurinol

A

Reduced urate production

76
Q

What may gouty arthritis be precipitated by

A

Diuretic therapy

77
Q

What is listeria particularly assosiated with

A

Pates and soft cheeses

78
Q

What is predominant in CSF of a listeria meningitis

A

Lymphocytes

79
Q

What is predominant in a CSF of bacterial meningitis

A

Neutrophils

80
Q

CSF abnormalities in bacterial meningitis

A

Opening pressure > 180
WBCs 10 - 10,000
Neutrophils predominate
CSF glucose < 0.4
Glucose < 2.2
Protein > 0.45

81
Q

What blood film would you see if you had metastatic ca with bony mets, and were anaemic

A

Nucleated RBCs

82
Q

What is seen on a blood film with haemolytic anaemia

A

Heinz bodies

83
Q

What is seen on a blood film with hyposplenism

A

Howell-Jolly bodies

84
Q

What is seen on a blood film of hereditary spherocytosis

A

Spherocytes

85
Q

Mechanism of action of amiodarone

A

K channel antagonist (delay in repolarisation, increasing AP and increased effective refractory period)

86
Q

Mechanism of action of digoxin

A

Inhibition of the sodium potassium ATPase

87
Q

What type of drug is donepezil

A

Acetylcholinesterase inhibitor

88
Q

Examples of acetylcholinestase inhibitors

A

donepezil
rivastigmine
galantimine

89
Q

Physiological effects of IPPV

A

Increased lung volumes
Increased intrathoracic pressure
Increased pulmonary vascular resistance
Reduced systemic BP
Reduced venous return and cardiac output

90
Q

WHat is tardive dyskinesia

A

Movement disorder assosiated with long term use of anti-psychotics

91
Q

What is akathisia characterised by

A

Motor restlesseness

92
Q

Septate hyphae and invovlement of sinuses suggect diagnosis of which infection

A

Aspergillus

93
Q

WHat supplies the pons

A

Branches of the basillar artery

94
Q

Tx for UTI in patients with efgr < 45

A

pivmecillinam

95
Q

Genetic basis for alzheimers disease

A

APOE e4 allele carriage

96
Q

Role of rivastigmine in PD

A

Symptoms of dementia

97
Q

What drug has a role in reducing “off periods” in PD

A

Entacapone

98
Q

Risk factors for osteonecrosis of the jaw secondary to bisphosphonate therapy

A

Dental caries (MOST IMPORTANT)
Smoking
> 65
Long term use of corticosteriods

99
Q

Scoring system to assess independence in patients with a stroke

A

Barthel index

100
Q

Treatment of LBD

A

Donepezil

101
Q

Treatment of restless legs syndrome

A

Gabapentin and pregabalin

102
Q

Management of N/V secondary to bowel obstruction in terminal care

A

Haloperidol

103
Q

Site of action of bendroflumethiazide

A

Distal convoluted tubule

104
Q
A

MRCP - Part 1 (20 decks)

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