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1
Q

FMF description and rx?

A

Familial Mediterranean Fever (FMF) is a genetic disorder characterised by recurrent episodes of painful inflammation in the abdomen, chest, or joints. These episodes are often accompanied by fever - rx with colchicine

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2
Q

A patient is started on finasteride for the treatment of benign prostatic hyperplasia. How long should the patient be told that treatment may take to be effective?

A

6M

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3
Q

Drugs exhibiting zero-order kinetics?

A

phenytoin
salicylates (e.g. high-dose aspirin)
heparin
ethanol

Please Stop Having Excessive (drinks)

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4
Q

Drugs affected by acetylator status?

A

isoniazid
procainamide
hydralazine
dapsone
sulfasalazine

I Pray He Doesn’t Stray

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5
Q

Once stable dose has been achieved of lithium how often should levels be checked?

A

3M

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6
Q

Miller Fisher triad and antibody?

A

Areflexia, opthalmoplegia, ataxia - anti GQ1B

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7
Q

Which measurement is not part of the diagnostic criteria of acute respiratory distress syndrome (ARDS)?

A

RR

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8
Q

Mode of action of evolocumab?

A

Prevents PCSK9-mediated LDL receptor degradation

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9
Q

Typically presents with proteinuria and is associated with early onset strokes or myocardial infarctions with a typical rash known as angiokeratomas?

A

Fabry disease

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10
Q

Extensive skin rash, high fever, and organ involvement?

A

DRESS - eosinophilia

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11
Q

Mechanism of mycophenolate?

A

Inosine-5’-monophosphate dehydrogenase inhibitor

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12
Q

Examples of calcineurin inhibitors?

A

Tacrolimus and ciclosporin

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13
Q

Examples of HMG-CoA reductase inhibitors?

A

Statins

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14
Q

Examples of ribonucleotide reductase inhibs?

A

Hydroxycarbamide

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15
Q

Can haloperidol be used in Parkinson’s?

A

No

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16
Q

Gold standard for GORD dx?

A

24hr oesophageal pH monitoring?

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17
Q

Protease and integrase?

A

Avir and gravir

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18
Q

First line meds for treating dementia? Second line?

A

Donepezil, rivastig, galanta - 1
Memantine - 2

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19
Q

Uncommon feature in visceral leishmaniasis?

A

Diarrhoea

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20
Q

What best describes the Bohr effect?

A

Increasing acidity (or PCO2) means oxygen binds less well to Hb

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21
Q

Dermatomyositis - most specific, most positive antibody?

A

Specific - anti Mi2
Positive - ANA

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22
Q

H Pylori strongest association?

A

Duodenal ulcers

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23
Q

Polymyositis antibody?

A

anti Jo1

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24
Q

HIV: anti-retrovirals - P450 interaction

A

Inducer - NNRTIs
Inhibitor - protease inhibitors

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25
Q

Interferon gamma role?

A

Activation of macrophages

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26
Q

Exo and endotoxin release?

A

Exotoxins - gram neg
Endotoxins - gram pos

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27
Q

Which constellation of signs on examination is the most consistent with a diagnosis of Guillain-Barre Syndrome?

A

Tachycardia, flaccid paralysis, hyporeflexia

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28
Q

Plasmodium vivax/ovale: cyclical fever every ? hours
Plasmodium malariae: cyclical fever every ? hours

A

48, 72

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29
Q

Mixed respiratory alkalosis and metabolic acidosis in a sweaty, confused patient point towards?

A

Salicylate OD

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30
Q

Eculizumab side effect?

A

C5-9 deficiency - must give neiss meningitis vaccination

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31
Q

C1-INH deficiency is associated with?

A

Hereditary angioedema

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32
Q

Deficiency in C1q, C1rs, C2 and C4 predisposes to?

A

SLE

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33
Q

C3 deficiency predisposes patients to?

A

Recurrent bacterial infections

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34
Q

C5 deficiency is seen in?

A

Leiner disease

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35
Q

C5-9 deficiency affects the formation of membrane attack complex (MAC), which is associated with?

A

Neisseria infections

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36
Q

Clostridium tetani and botulinum receptors?

A

Tetani - GABA and glycine
Bot - Ach

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37
Q

cANCA and pANCA associations?

A

cANCA - GPA
pANCA - eosinophilic granulomatosis with polyangiitis

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38
Q

Hyperintense T2 signal extending across the spinal cord, between the levels of T9 and T12 + spastic leg weakness?

A

Transverse myelitis

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39
Q

Causative organism for rocky mountain spotted fever?

A

Rickettsia ricketsii

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40
Q

Biclutanamide action?

A

Androgen receptor blocker

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41
Q

Faecal elastase is a useful test of?

A

Exocrine function in chronic pancreatits

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42
Q

Local anaesthetic toxicity can be treated with?

A

Lipid emulsion

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43
Q

MSH2 gene function?

A

DNA mismatch repair

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44
Q

Fred ataxia inheritance?

A

Auto recessive

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45
Q

X-ray findings - cupping and fraying of metaphyseal region? Disease and mechanism?

A

Rickett’s - excess of non-mineralized osteoid at the growth plate

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46
Q

A 45-year-old with a history of untreated HIV presents with a 3-week history of gradual onset headaches and altered mental status. He also complains of nausea but denies fever or visual changes.
On examination, he is slightly disoriented, with mild nuchal rigidity and a Glasgow Coma Scale of 14.
Dx and investigation?

A

Diagnosis - cryptococcus
Investigation - CSF India Ink

47
Q

Prior to urea breath test how long should abx and PPIs be stopped for?

A

Abx - 4 weeks
PPI - 2 weeks

48
Q

Bloody diarrhoea in which infections?

A

Campylo, amoeba, shigella

49
Q

HNPCC associations?

A

Colorectal and endometrial cancer

50
Q

Drugs precipitating AACG?

A

TCAs + anticholinergics

51
Q

Escalation of steroids in eczema?

A

1- hydrocortisone 2- clobethasone 3 - betamethasone 4 - clobetasol

52
Q

AL vs AA Amyloidosis?

A

AA - RA, bronchiectasis, TB
AL - more common, seen in myeloma and other haem conditions

53
Q

Intracellular proteins tagged with extensive ubiquitination?

A

Proteasome

54
Q

Ejection fraction calculation?

A

EF = (EDV-ESV)/EDV

55
Q

Stills disease - blood results?

A

Neg rheumatoid factor, raised CRP ESR

56
Q

Abx to give with human tetanus immglob?

57
Q

Virus linked to oropharyngeal cancer?

58
Q

Indications for pacing?

A

Sinus pause > 3 secs, persistent brady, mobitz type 2, trifasci block

59
Q

Block and replace vs carbimazole regimes - which is shorter?

60
Q

A family history of breast and ovarian cancer suggests a mutation in which gene?

61
Q

Which HLA subtype implicated in hyperacute rejection?

62
Q

Minimal change disease associated with which condition?

63
Q

Hep B post exposure?

A

Monthly monitoring of Hep C RNA

64
Q

Listeria rx in over 60s or immsuppressed?

A

Amox and ceftriaxone

65
Q

Serious ADR of bosentan?

A

Liver toxicity

66
Q

Cytokine involved in acute phase response?

67
Q

Bronchial carcinoid markers?

A

Chromogranin A + neuron specific enolase

68
Q

Standard deviation and variation relationship?

A

Variance = square of standard deviation

69
Q

Relative risk reduction?

A

Relative risk reduction = (EER - CER) / CER

70
Q

Standard error of the mean?

A

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

71
Q

What can ondansetron cause?

A

Prolongation of QT => polymorphic VT

72
Q

Difference between pons and cerebrum lesions?

A

Pons - ipsilateral facial weakness Cerebrum - contralat weakness

73
Q

Ondansetron mechanism?

A

5 HT3 antagonist

74
Q

Sulphonylureas mechanism?

A

Closes K ATP on beta cells

75
Q

Patients who are high-risk for contrast-induced nephropathy should have xxxx withheld for xxxx after procedure?

A

Patients who are high-risk for contrast-induced nephropathy should have metformin withheld for a minimum of 48 hours and until the renal function has been shown to be normal

76
Q

Interferon alpha beta and gamma - produced where and used where and which receptors?

A

type 1 - alpha beta
type 2 - gamma
alpha - leucocytes, antiviral
beta - fibroblasts, antiviral - used in MS
gamma - natural killer cells/T cells, weak antiviral used to immunomodulate

77
Q

Dendritic corneal ulcer rx?

A

Topical antiviral

78
Q

Which cells secretes the majority of tumour necrosis factor in humans?

A

Macrophages

79
Q

Which diuretic to reduce calcium? Opposite effect?

A

Indapamide, furosemide

80
Q

What is important in PCR?

A

A thermostable DNA polymerase is required

81
Q

His GP would like to commence him on a medication that does not cause weight gain or hypoglycaemia.

What is the likely mechanism of action of this drug?

A

DPP4 inhibitor - gliptin

Reduces breakdown of incretins

82
Q

Osteomalacia?

A

Low ca and po4, raised ALP + PTH

83
Q

In ITP which molecule are autoantibodies targetting?

A

Glycoprotein

84
Q

Diarrhoea and hypokalemia in context of colon pathology?

A

Villous adenoma

85
Q

Blockage of calcium 1.2 channels?

A

Verapamil/diltiazem

86
Q

Blockage of calcium 2.3 channels?

A

R type channels

87
Q

Blockage of K 1.11 channels?

A

Amiodarone

88
Q

Vitamin B2 def can cause?

A

Riboflavin - angular chelitis

89
Q

Basket weave appearance on microscopy, haematuria, proteinuria?

A

Alport’s syndrome

90
Q

Horner’s syndrome - anhydrosis determines site of lesion:
head, arm, trunk? face? absent?

A

head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast’s, cervical rib
absent = post-ganglionic lesion: carotid artery

91
Q

Brush border enzymes:
maltase?
sucrase?
lactase?

A

glucose + glucose
glucose + fructose
glucose + galactose

92
Q

First-order neuron?
Second-order neuron?
Third-order neuron?

A

First-order neuron: Detects the stimulus and transmits the signal to the spinal cord or brainstem.
Second-order neuron: Relays the signal within the spinal cord or brainstem and often crosses over to the opposite side.
Third-order neuron: Transmits the signal from the thalamus to the brain’s sensory cortex for processing and awareness.

93
Q

Stroke - UMN or LMN, Bells - UMN or LMN?

A

Stroke - UMN - spares the forehead
Bells - LMN

94
Q

Auditory agnosia in which lobe?

A

Temporal lobe

95
Q

Hereditary haemorrhagic telangiectasia inheritance?

A

Autosomal dominant with age related penetrance

96
Q

Is WPW an indication for ICD?

97
Q

A 35-year-old male presents to the clinic with bilateral pitting oedema, lower limb pain and tingling in both arms. On examination, tiny, painless papules were noticed on his abdomen and a whorl-like corneal pattern of cream-coloured lines in the patient’s cornea. He has no significant past medical history. Diagnosis?

A

Fabry’s disease

98
Q

Early LVF sign?

99
Q

Where are Dohle bodies found?

A

Leukaemoid reaction

100
Q

Indinavir association?

A

Kidney stones

101
Q

Cyclophosphamide mechanism and ADRs?

A

Cross linking DNA, haemorrhagic cystitis, TCC, myelosuppression

102
Q

Bleomycin mechanism and ADRs?

A

Blasts preformed DNA, lung fibrosis

103
Q

Doxorubicin mechanism and ADRs?

A

Stabilises complex and inhibits DNA + RNA synthesis, cardiomyopathy

104
Q

Methotrexate ADRs?

A

Myelosuppresion, mucositis, liver and lung fibrosis

105
Q

5-FU mechanism and ADRs?

A

Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during S phase), myelosuppression, mucositis, dermatitis

106
Q

6-mercaptopurine mechanism and ADRs?

A

Purine analogue, myelosuppression

107
Q

Cytarabine mechanism and ADRs?

A

Pyrimidine antagonist, myelosuppression

108
Q

Vincristine mechanism and ADRs?

A

Inhibits formation of microtubes, peripheral neuropathy and paralytic ileus

109
Q

Docetaxel mechanism and ADRs?

A

Prevents microtubes depolymerisation, neutropenia

110
Q

Irinotecan mechanism and ADRs?

A

Inhibits topoisomerase I, myelosupp

111
Q

Cisplatin and hydroxyurea mechanism and ADRs?

A

Cisplatin - cross linking, nephro and ototox, peripheral neuropathy, hypomag
Hydroxyurea - inhibits ribonucleotide reductase, myelosupp

112
Q

When does CIN develop - contrast nephropathy?

A

2-3 days later

113
Q

PH positive and neg response?

A

Pos - nifedipine
Neg - bosentan

mrcp 1 (18 decks)

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