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MRCP 2 > ID, Haemonc, GUM, Opthal, psych, geris > Flashcards

ID, Haemonc, GUM, Opthal, psych, geris Flashcards

1
Q

Anal sex, now painful defecation with flecks of blood and tender inguinal lymph nodes

A

Lymphogranuloma verenum

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2
Q

What previous op have they had if iron and b12 deficiency

A

partial gastrectomy

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3
Q

Abdominal pain, and neuropsych disorder
rx?

A

Acute intermittent porphyria
IV haem arginate

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4
Q

Meningitis following neurosurgical procedure usually?

A

S epidermis

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5
Q

Cervicitis with discharge - abx to prescribe

A

Single dose cef
+ 14 days doxy + metronidazole

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6
Q

NHL given chemo. Now anaemia with low/normal reticulocytes. Normal platelets / wcc

A

Paravirus infection
[autoimmune haemolytic anaemia would have raised reticulocytes]

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7
Q

Gross haematuria and mass on kidney in CT. Next step?

A

Urology + radical nephrectomy

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8
Q

Branch retinal vein vs artery on fundocsopy

A

Vein - flame haemorrhages and engorge vessels

Artery - pail and absent vessels

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9
Q

Female - 6 weeks Hx lower abdo pain, occasionally feverish.
Prev UTIs, normal dipstick =

A

PID

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10
Q

Type A vs B arotic dissection and rx?

A

A - ascending aorta
-> urgent surgery

B - doesn’t involve ascending aorta
-> Labetalol first

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11
Q

Evidence of end organ damage in myeloma

A

C - Ca >2.75
R - renal impairment
A - anaemia <100
B - Bone lesions

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12
Q

Gent renal damage is from damage to

A

proximal tubule

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13
Q

recurrent breeast Ca, why HyperCa

A

Production of PTH-Related protein

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14
Q

unwell with diarrhoea, neuro sx, schistocytes, thrombocytopenia and only mild renal impairment =?
rx?

A

TTP
Plasma exchange

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15
Q

Fever, anaemia, thrombocytopenia neuro/ renal abnormalities

A

TTP

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16
Q

Any hints of infective endocarditis needs

A

serial blood cultures

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17
Q

Immunocompromised with fever, cough, red conjunctiva and this spreading morbilliform rash = ? ix?

A

Measles
NPA aspirate as immunocompromised so measles IgM might not be positive

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18
Q

Reversal of Apixaban?
rivaroxiban?
Dabigatran?
heparin?
LMWH?

A

Apixaban - Andexanet alpha
rivaroxiban - andexanet alpha
Dabigatran - Idarucizumab
heparin - protamine
LMWH - protamine

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19
Q

Had whooping cough for several weaks - best Ix?

A

serology

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20
Q

Fresh water exposure, now headaches fevers and jaundice =? rx?

A

Lepto
BenPen / cef

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21
Q

Doxy mechanism

A

Inhibits 30s subunit of ribosomes

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22
Q

Which abx inhit 50s subunit of ribosomes

A

Macrolides
Clinda
Linezolid

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23
Q

Inhibit steroid hormone synthesis drug?

A

Mitotane

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24
Q

Any presentation of self harm should get

A

Psychosocial assessment prior to discharge

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25
Q

55M lethargy.
Anaemia, WCC 55, thrombocytopenia
Cytogenetitcs t: 15 :17
Dx?
Derranged clotting why?
rx?

A

APML
Get DIC -> platelets, FFP, cryo
ATRA - (Vit A)

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26
Q

Most likely primary Ca

A

Renal - cannonball mets

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27
Q

ewings sarcoma poor prognostic features

A

Anaemia
Male sex
Raised LDH

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28
Q

Pregnant exposire to VZV rx?

A

VZV antibody testing
-> VZV Ig if neg

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29
Q

Weight loss, worsening diabetic control, skin rash =?
describe rash? ix?

A

Glucagonoma
glucagon levels and CT of pancreas

Rash is necrolytic migratory erythema

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30
Q

HZV on tip of nose makes you worried about?

A

‘hutchinsons sign’ = likely Opthal HZV
-> opthal opinion + IV aciclovir

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31
Q

Symptoms pyelonephritis with temp 39.4 rx?

A

Urine culutre fist
then IV Abx

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32
Q

LFTs in cirrhossis to suggest development of HCC

A

Sudden increase in ALP

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33
Q

neutropenic sepsis Rx?

A

IV Taz
[gent no longer recommended]

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34
Q

Swelling of lower legs
Itching and crusting

A

varicose eczema

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35
Q

HIV - excoriated papules and pustules on chest, back and arms =

A

Eosinophilic folliculitis

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36
Q

Excercise now unable to see out left eye =

A

left-sided carotid dissection

Ptosis and miosis visible

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37
Q

Small cell lung Ca with ipsilateral node involvement rx

A

Combination chemo + radio

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38
Q

Visits jungle get a warty lump on arm which heals up. Now maculopapular rash

A

Yaws

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39
Q

RUQ discomfort
hepatomegaly
CEA 2x normal and Ca-19-9 10x normal
Normal AFP
=?
Ca-19-9 =?

A

Intrahepatic colangiocarcinoma

pancreas, gallbladder, lung, or colon.

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40
Q

Several months of low mood, low energy, difficulty sleeping
Auditory hallucinations saying he is worthless

A

Depression

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41
Q

Who should get a DXA scan

A

Anyone post menopausal / older men with fragility fracture
Eg Collies, vertebral wedge, or NOF

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42
Q

university with severe pain in eye and Hx of back problems
Describe eye

A

Anterior uveitis - with oval pupil

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43
Q

Headaches, anaemia, raised IgM

A

Waldenstrom

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44
Q

Whats it called when nucleated red cells or myelocytes seen on blood film

A

leuco-erythroblastic anaemia

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45
Q

Whats it called when nucleated red cells or myelocytes seen on blood film

A

leuco-erythroblastic anaemia

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46
Q

Whats it called when nucleated red cells or myelocytes seen on blood film

A

leuco-erythroblastic anaemia

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47
Q

Presents like anorexia + irregular patchy alopecia
firm compressible mass in LUQ =?

A

trichobezoar
[Eating own hair]

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48
Q

Anaemia with splenomegaly

A

Hereditary spherocytosis
loss of central pallor

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49
Q

On tamoxifen for breast Ca, periods stopped and debilitating hot flushes rx?

A

Progesterone
eg megestrol, norhisterone….

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50
Q

Renal Ca needs nephrectomy then?

A

Treatment with a kinase inhibitor
Eg Sunitinib / pazopanib

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51
Q

Asian man with anaemia and low MCV but normal ferritin Ix?

A

Hb electrophoresis

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52
Q

HIV 1 week headache with focal signs

A

Toxo

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53
Q

Given Benpen for syphilis and within 1 minute visual hallucinations and agitation

A

Procaine reaction

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54
Q

Post partum, foul smelling dischage. Erythema around episiotomy site and abdo tenderness
Ix?

A

Endometriitis
High vag swab

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55
Q

painless loss of vision ? rx?

A

Central RAO

Any of
-Acetazolomide + mannual massage
-Thrombolysis
-Anterior chamber paracentesis

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56
Q

Key complication of diphtheria

A

Myocarditis

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57
Q

Clue in question for leigonaiires vs mycoplasma

A

Leigon - HypoNa, travel

Mycoplasma - erythema multiform, haemolytic anaemia
preceding flu like illness

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58
Q

Low ristocetin co factor (RoCF) level means

59
Q

Heaches blurred vision, weight loss purpuric rash, lymphadenopathy
Marrow - infiltration with lymphoplasmacytoid cells

A

Waldenstrom

60
Q

HIV - red tender leisions on shins
subacute cavitating pneumonia

A

Histoplasma

61
Q
62
Q

Dermatomyositis with HyperCa

A

SSC of lung

63
Q

Pancytopenia
Marrow - increased cellularity with ring sideroblast cells

A

Myleodysplasia

64
Q

What do you need post resection of RCC

A

VGEF or immunotherapy eg sunitinib

65
Q

Poor prognosis in kids ALL

A

pHILADEPHIA 9:22

66
Q

Which infection mimics appendicitis

A

Yersinia entercolitica

67
Q

Haemorrhage on apixaban what can be used if no reversal agent adexenat

A

Prothrombin complex concentrate

68
Q

For MGUS what is M protein level? Plasma cells on marrow?

A

M protein <30g/l
plasma <10%

69
Q

Atypical lymphocytes with abnormal villous projections

A

Hairy cell leukaemia
[hair like projections]

70
Q

few weeks Night sweats weight loss
thickened bowel wall and ++ LDH

A

burkits lymphoma - get spontaneous tumour lysis as grows rapidly

71
Q

bacteria infecting a joint prothesis but no real symptoms and not bad at all

72
Q

Gangrene caused by? rx/

A

C perfringes
benpen + clinda

73
Q

ovarian ca chemo regime

A

paclitaxel and carboplatin

74
Q

2 malignancies commonly with hyperviscosity

A

waldenstron
myeloma

75
Q

CBT for body dysmorphic disorder

A

exposure and response prevention

76
Q

Warfarin overdose and bleeding but no prothrombin complex available

77
Q

Which testi Ca has ++ HCG levels

A

choriocarcinoma

78
Q

2 month hx flu like sx and endocarditis

79
Q

Which abx most impicated C dif

A

cipro
clinda
cefalosporins

80
Q

Peutz jehger inheritance? gene?

A

Dominant
STK11

81
Q
A

Hypertensive retinopathy
optic disk oedema, cotton wool spots
haemorrhages, AV nipping

82
Q

Sickle cell crisis anagesia

A

IV mophine (rather than fentanyl)

83
Q

Previous rx with cyclophosphamide years ago now haematuria

A

Bladder Ca

84
Q

Shigella 1st line UK

85
Q

Immunocompromised. Exposed to VZV. IgG positive on test
rx?

A

reassure - only need IVIg if neg

86
Q

Long term tamoxifen common comp?

87
Q

Flu A Drug and class

A

oseltamvir
neuraminidase inhibitor

88
Q

methaemoglobin rx

A

methyline blue
Low Sa02 with high PaO2

89
Q

Pancoast tumour with horners - what happens with atropine and pupil

A

constricted pupil that does not dilate with atropine properly

90
Q

Loss of vision and vague discomfort over 2 days

A

central RVO

91
Q

Sudden onset eye pain fixed dilated pupil

92
Q

Young person acute agitation needing IM sedation

A

Loraz
risk of dystonic reactions with haloperidol in young

93
Q

Young gal lower abdo pain for 9 days with post coital bleeding.
Neutrophils on cervical smear

94
Q

T2DM worsening acuity =? rx?

A

Hard exudates and haemorrhage within 1 optic disc diameter of macula = macular oedema

VGEF inhibitors / focal laser therapy

95
Q

What speeds up mesothelioma progression

A

Prev radiation exposure

96
Q

FHx of splenectomy
recent flu like illness and now epistaxis and platelets 16 = ?
RX? second line?

A

ITP

steroids

IVIg

97
Q

When add methylpred to co-trimox in Pneumocystis rx?

A

PO2 <9.3
spo2 <92%

98
Q

Oxaliplatin chemo key side effet

A

Peripheral neuropathy

99
Q

Sudden loss of vision

A

Branch RVO

100
Q

HUS new 1st line rx if required

A

eculizumab
(binds to C5)

101
Q

Flu with resistance to oseltamivir?

A

Inhaled zanamivir

102
Q

t 15:17?
t 8:14?
t 9:22?

A

t 15:17 - acute promyelocytic leukaemia
t 8:14 - burkits lympoma
t 9:22- philadephia

103
Q

PCP prophylaxis if no co-trimox? What if g6pd?

A

Dapsone second line
Inhaled pentamidine if G6PD

104
Q

Often gets a stuffy nose, No response to Hep / tetanus vaccinations

A

IgA deficiency

105
Q

HyperCa key Rx

A

IV fluids
then bisphosphonates

106
Q

What type of blood for haemonc

A

Irradiated
Doesn’t need to be CMV negative

107
Q

Farmer with cut on leg goes into some drainage ditches and now has hepatitis with ++ bili and thrombocytopenia? rx?

A

Lepto
Benpen

108
Q

Headaches lethargy back pain. Severe renal impairment, ++ raised viscosity and protein with low albumin

A

Myeloma

[Dont get bone pain in waldenstrom]

109
Q

Most common complication of endpcarditis

A

emboli stroke

110
Q

Scaring on legs from old sores in childhood
+tremponema agglutination but negative RPR

111
Q

Which antipsychotic best for psychosis in Parkinsons

A

quetiapine
[Quiet them down without reactions]

112
Q

Who gets 5-FU toxicity

A

Deficiency of DPD enzyme

113
Q
114
Q

coxiella dx?

A

complement fixation

115
Q

long standing RheumA. Now raised bili, low hapto, low platelets

A

Haemolytic anaemia
direct antiglobin test

116
Q

65 headaches rasied Hb, mass in LUQ

A

Polycythaemia

117
Q

Does HepC have PEP?

118
Q
A

STE 1, AvL
= High lateral MI
[branch of LAD]

119
Q

virulence factor for nec fasc

120
Q
A

Optic disc oedem
cotton wool spots
AV nipping

= hypertensive retinopathy

121
Q

pancytopenia and positive TRAP stain

A

hairy cell leukaemia

122
Q

TRAP stain
Sudan black B stain
TDT stain
LAP stain

A

TRAP stain - hairy cell leukaemia

Sudan black B stain - AML

TDT stain - ALL

LAP stain - Polycythaemia and myelofibrosis

[Trap Hairs, AM sudanise

123
Q

Which meds Llower b12 absorption

124
Q

Gonococcal septic arthritis most likely to be seen on aspirate

A

Neutrophils

[gonno only found in 25% of aspirates]

125
Q

Gram-positive rod causing diarrhoea morning after BBQ

A

c perfringes

126
Q
A

Trifasicular block

Right bundle branch block
Left axis deviation (= left anterior fascicular block)
First degree AV block

127
Q
A

Trifasicular block

Right bundle branch block
Left axis deviation (= left anterior fascicular block)
First degree AV block

128
Q

2 ways an ecg shows bifasicular block

A

Right bundle branch block (RBBB) with left anterior fascicular block (LAFB), manifested as left axis deviation (LAD)

RBBB and left posterior fascicular block (LPFB), manifested as right axis deviation (RAD) in the absence of other causes

129
Q
A

bifascicular block pattern: RBBB combined with LAFB (manifested as LAD)

130
Q
A

Bifasicular block
RBBB with LAFB

RBBB pattern in precordial leads with RSR’ complex in V1-2
Prominent LAD indicating LAFB

131
Q

Acquired factor VIII deficiency Rx

A

Factor VII
[not VIII]

132
Q

Prolonged Hx of dry cough worst in cold air

A

Bordetella pertusus

133
Q

Which antipsychotic particularly related do developing diabetes

A

Olanzapine

[Big O fatty]

134
Q

14 days post renal Tx
Flu like symptoms and sore throat

135
Q

Family Breast and melanoma Ca gene

136
Q

1st thing to rise following MI? most specific?

A

Myoglobin first to rise

Trop I most specific

137
Q
A

Dry age-related macular degeneration

138
Q

Bitten by tick
Anaemia and jaundice

139
Q

HPV anogenital warts 1st line? if preg?

A

Topical podophyllotoxin

Cryotherapy if preg

140
Q

Bacilus cerrus endocarditis rx

141
Q

VP shunt with signs of raised pressure initial Ix

A

MRI
Not CT

142
Q

How to treat TTP if no plasma exchange available

A

Need to increase ADAMTS13
- FFP
- Steroids to strop antibody production
- consider rituxumab

143
Q

Rx cmv if increasing Viral load despite rx with vaniclovir

144
Q

Diffuse alveolar haemorrhage rx

A

High dose steroids
+ etanercept

MRCP 2 (5 decks)

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