Mock Exam Notes Flashcards
1
Q
tear drop poikilocytes
A
myelofibrosis
2
Q
chlamydia treatment
A
doxycycline is preferable to azithromycin
3
Q
management of stroke and TIA
A
clopidogrel
carotid endarterectomy only if stenosis >50 or 70% depending on guideline
4
Q
ethylene glycol toxicity management
A
fomepizole
also ethanol
and haemodialysis if metabolic acidosis has developed
5
Q
testing for haemochromatosis
A
general population - transferrin saturation > ferritin
family member of affected = HFE genetic testing
6
Q
why would coeliac testing be negative if all symptoms correlate
A
selective IgA deficiency
7
Q
CML translocation
A
t(9:22)(q34:q11). BCR-ABL gene
poor prognosis in ALL
8
Q
Burkitts translocation
A
t8:14
MYC oncogene
9
Q
Mantle cell translocation
A
t11:24, cyclin D1 (BCL1) gene
10
Q
Follicular lymphoma translocation
A
t14:18
11
Q
APML translocation
A
t15:17
fusion of PML and RAR-alpha
12
Q
Beta blocker overdose
A
atropine, IV glucagon in resistant cases
13
Q
renal transplant + infection
A
?CMV
14
Q
loud S1 in
A
mitral stenosis
15
Q
soft S2 in
A
aortic stenosis
16
Q
S3 heard if
A
LVF (dilated cardiomyopathy) - gallop rhythm
constrictive pericarditis (pericardial knock)
mitral regurg
17
Q
S4 heard when
A
aortic stenosis
HOCM (double apical impulse)
HTN
coincides with p wave on ECG
18
Q
P450 inducers
(ie lowered INR)
A
SCRAP GPS
sulfonylureas
carbamazepine
rifampin
alcohol (CHRONIC)
phenobarbital
griseofulvin
phenytoin
st johns wort
19
Q
P450 inhibitors
(ie raised INR)
A
SICKFACESCOM
sulfonamides
isoniazid
cimetidine
ketoconazole
fluconazole
alcohol (ACUTE)
ciprofloxacin
erythromycin
sodium valproate
chloramphenicol
omeprazole
metronidazole
20
Q
Barrter’s syndrome
A
autosomal recessive
severe hypokalaemia
defect in NKCC2 in asc LOH
normotension
presents with failure to thrive, polyuria and polydipsia and weakness
21
Q
Alport’s syndrome
A
x linked dominant
defect in gene for T4 collagen leading to abnormal GBM
more severe in males
failing renal transplant
presents with-
microscopic haematuria
progressive renal failure
bilateral sensorineural deafness
lenticonus
retinitis pigmentosa
splitting of lamina densa on electron microscopy
diagnosis - molecular genetic testing
renal biospy - basket-weave appearance
22
Q
screening test for ADPKD
A
USS abdo
23
Q
causes of upper zone fibrosis
A
CHARTS
coal workers pneumoconiosis
histiocytosis/hypersensitivity pneumonitis
ank spond
radiation
TB
sarcoid/silicosis
24
Q
causes of lower zone fibrosis
A
IPF
CTD
Drug - amiodarone, bleomycin, methotrexate
Asbestosis
25
normal ABPI
0.9-1.2 (<0.9 = arterial disease, also >1.2 in diabetics with calcification)
26
Churg-strauss stages of presentation
1) allergy - asthma, allergic rhinitis -> nasal polyps
2) eosinophilia
3) vasculitis -> kidneys, lungs, heart
27
Marfan's is due to a defect in
fibrillin-1
28
COPD Mx
1st line = SABA/SAMA
asthmatic features?
N = LABA+LAMA
Y = LABA+ICS -> +LAMA
theophyllines only after ^ if cannot have inhaled
29
Heyde's syndrome
aortic stenosis and colonic angiodysplasia
reduction in vWF as blood passes through narrow valve
30
idiopathic membranous glomerulonephritis
antiphospholipase A2 antibodies
MGN - spike and dome
31
fixed and dilated pupil with down and out eye, following history of traumaa
raised ICP -> third nerve palsy due to uncal or trans-tentorial herniation
32
GPA presentation
upper respiratory tract signs, haemoptysis, epistaxis/earache, crusting, sinusitis, hearing loss, blocked/runny nose
ENT + RESP + KIDNEY
33
drug-induced lupus causes
procainamide
hydralazine
isoniazid
minocycline
phenytoin
34
which organelle is responsible for the catabolism of long chain fatty acids
peroxisome
35
HLA A3
haemochromatosis
36
HLA B51
Behcets
37
HLA B27
Ank spond
reactive arthritis
acute anterior uveitis
psoriatic arthritis
38
HLA DQ2/DQ8
coeliac
39
HLA DR2
narcolepsy
Goodpastures
40
HLA DR3
dermatitis herpetiformis
Sjogrens
PBC
41
HLA DR4
T1DM
RA - DRB1 gene
42
which cytokine activates macrophages
IFN gamma
43
IL2 is secreted from
macrophages
44
IL3 stimulates
proliferation and differentiation of myeloid progenitor cells
45
IL4 is responsible for
proliferation of B cells
46
TNF alpha is responsible for
acute fevers and neutrophil chemotaxis
47
CD 15 is found on
Reed-Sternberg cells
48
CD1 is
MHC molecule that presents lipid molecules
49
CD4
found on helper T cells
co-receptor for MHC class 2
used by HIV to enter T cells
50
CD5
mantle cell lymphomas
51
CD8
found on cytotoxic T cells
co-receptor for MHC class 1
myeloid dendritis cells
52
CD14
cell surface marker for macrophages
53
CD16
binds to Fc portion of IgG antibodies
54
CD21
receptor for EBV
55
CD28
interacts with B7 on antigen presenting cell
56
CD56
marker for NK cells
57
CD95
FAS receptor, apoptosis
58
MI secondary to cocaine should be given
IV benzodiazepines
59
mechanism of cyanide toxicity
inhibits mitochondrial enzyme cytochrome c oxidsae
60
depletion of glutathione stores
paracetamol toxicity
61
Cushing reflex
hypertension and bradycardia
attempt to increase MAP
62
Waldenstrom's
organomegaly with no bone lesions
no bone pain - instead hyperviscosity pain eg headaches
can still have bence jones protein
63
first line investigation for stable chest pain of suspected CAD aetiology
contrast enhanced coronary CT angiography
64
paralysis of all intrinsic hand muscles
C8-T1 nerve root damage
Klumpke
65
Erb's palsy
C5-6
loss of sensation in arm and paralysis of deltoid, biceps and brachialis
66
Lateral medullary syndrome
facial and contralateral body loss of pain sensation along with nystagmus and ataxia
PICA stroke
AICA - same but with same side face weakness and loss of hearing
67
C5-9 deficiency
predisposes to neisseria meningitidis infections
68
C1q, C1rs, C2, C4 deficiency (classic pathway components)
predisposes to SLE
69
C5 deficiency
Leiner disease - diarrhoea, wasting, seborrhoeic dermatitis
70
C1 inh deficiency
hereditary angioedema
71
C3 deficiency
recurrent bacterial infections
72
cataracts - drug cause
steroids
73
corneal opacities - drug cause
amiodarone, indomethacin
74
optic neuritis - drug cause
ethambutol
amiodarone
metronidazole
75
sildenafile eye ADR
blue discolouration
non-arteritic anterior ischaemic neuropathy
76
inverted champagne bottle legs and clumsiness
CMT
77
Gastrin
G cells in antrum of stomach
distension of stomach, vagus nerves
inhibited by low pH, somatostatin
increases acid secretion by gastric parietal cells, pepsinogen and IF secretion, increases gastric motility
78
CCK
I cells in upper small intestine
Increases secretion of enzyme-rich fluid from pancreas, contraction of gallbladder and relaxation of sphincter of Oddi, decreases gastric emptying, trophic effect on pancreatic acinar cells, induces satiety
79
secretin
S cells in upper small intestine
Increases secretion of bicarbonate-rich fluid from pancreas and hepatic duct cells, decreases gastric acid secretion, trophic effect on pancreatic acinar cells
80
VIP
small intestine, pancreas
Stimulates secretion by pancreas and intestines, inhibits acid secretion
81
Somatostatin
D cells in pancreas and stomach
Decreases acid and pepsin secretion, decreases gastrin secretion, decreases pancreatic enzyme secretion, decreases insulin and glucagon secretion
inhibits trophic effects of gastrin, stimulates gastric mucous production
82
AV block can occur following
inferior MI
83
cell cycle
G0 - resting, quiescent cells (hepatocytes, neurons)
G1 - cells increase in size, determines length of cell cycle, influence p53
S - synthesis of DNA, RNA, histone; centrosome duplication
G2 - cells continue to increase in size
M - mitosis, cell division, shortest phase
84
Jarisch herxheimer
fever, rash, tachycardia after the first dose of antibiotic
in contrast to anaphylaxis, there is no wheeze or hypotension
it is thought to be due to the release of endotoxins following bacterial death and typically occurs within a few hours of treatment
no treatment is needed other than antipyretics if required
85
in which stage of mitosis does vincristine act
metaphase
taxanes - metaphase
antimetabolites - S phase
anthracyclines - S phase
topoisomerases - mitosis and meiosis
86
pathogenesis of Fanconi syndrome
generalised disorder affecting tubular resorption in the PCT
There is increased excretion of nearly all amino acids, glucose, bicarbonate, phosphates, uric acid and potassium. Features include polyuria, polydipsia, rickets, hypokalaemia, hypophosphatemia, growth failure and acidosis.
87
Liddle's syndrome mutation
inability to degrade epithelial sodium channels located at the DCT
Classically patients may experience hypertension, hypokalaemia and metabolic alkalosis. Amiloride counters this by selectively blocking the epithelial sodium transport channels in the DCT and collecting duct.
88
Gitelman syndrome
rare autosomal recessive disorder which occurs due to a mutation causing a resorptive defect of the sodium chloride co-transporter. It is characterised by hypokalemia-hypomagnesemia and alkaline urine.
89
bilateral spastic paresis and loss of pain and temperature sensation
anterior spinal artery occlusion
The anterior spinal artery supplies the anterior portion of the spinal cord. This leads to bilateral motor and sensory paralysis below the level of the infarct. There is sparing of the dorsal column medial lemniscal pathway preserving proprioception. As well as this autonomic dysfunction inferior to the level of the lesion is seen. This condition is most commonly due to atherosclerosis, risk factors include diabetes, hypertension and anything else causing a hypercoagulable state.
90
ECG abnormalities associated with hypercalcaemia
shortening of the QT interval. Osborne (J) waves may also be seen in more severe cases. If the hypercalcaemia is not corrected, ventricular arrhythmias like Ventricular Fibrillation can develop.
91
dexamethasone suppression test
Cushing's disease (ACTH secreting pituitary adenoma), cortisol is not suppressed by low-dose dexamethasone but is suppressed by high-dose dexamethasone
exogenous steroid use, the plasma ACTH would be decreased
With ectopic ACTH from small cell lung cancer, cortisol would not be suppressed by low dose or high-dose dexamethasone.
With cortisol secretion from an adrenal adenoma, cortisol would not be suppressed by low-dose or high-dose dexamethasone.
92
salicylate overdose mx
general (ABC, charcoal (within an hour of OD))
urinary alkalinization with intravenous sodium bicarbonate - enhances elimination of aspirin in the urine
haemodialysis
93
triangle of safety for chest drain
base of the axilla, lateral edge pectoralis major, 5th intercostal space and the anterior border of latissimus dorsi
94
eczema herpeticum cause
HSV1
coxsackie
95
first hormone secreted in response to hypoglycaemia
glucagon -> GH and cortisol
96
coved ST-segment elevation in leads V1-V3 with T wave inversion, gene mutation
SCN5A
CASQ2 is a gene for cardiac calsequestrin, a calcium-binding protein that plays a key role in cardiac regulation. Mutations in this gene lead to catecholaminergic polymorphic ventricular tachycardia (CPVT).
KCNQ1 and KCNH2 are both genes encoding for potassium channels. Defects in these can lead to long-QT syndrome (Romano-Ward) or short-QT syndrome.
RYR2 encodes for the ryanodine receptor found in cardiac muscle. Mutations in RYR2 are associated with catecholaminergic polymorphic ventricular tachycardia (CPVT) and arrhythmogenic right ventricular dysplasia.
97
widening of wrist joints
rickets, due to excess non-mineralised osteoid at growth plate
98
microtubule function
guide movement during intracellular transport and help bind internal organelles
99
what can reduce absorption of levothyroxine
iron
calcium carbonate
100
chlamydia psittaci treatment
tetracyclines
macrolides
101
fastest conduction velocities in the heart
Purkinje fibres
102
lung volumes
Tidal volume (TV)
volume inspired or expired with each breath at rest
500ml in males, 350ml in females
Inspiratory reserve volume (IRV) = 2-3 L
maximum volume of air that can be inspired at the end of a normal tidal inspiration
inspiratory capacity = TV + IRV
Expiratory reserve volume (ERV) = 750ml
maximum volume of air that can be expired at the end of a normal tidal expiration
significantly reduced in obesity (increased abdominal fat mass pushes up against the diaphragm, reducing the volume of air that can be expelled)
Residual volume (RV) = 1.2L
volume of air remaining after maximal expiration
increases with age
RV = FRC - ERV
Functional residual capacity (FRC)
the volume in the lungs at the end-expiratory position
FRC = ERV + RV
Vital capacity (VC) = 5L
maximum volume of air that can be expired after a maximal inspiration
4,500ml in males, 3,500 mls in females
decreases with age
VC = inspiratory capacity + ERV
Total lung capacity (TLC) is the sum of the vital capacity + residual volume
Physiological dead space (VD)
VD = tidal volume * (PaCO2 - PeCO2) / PaCO2
where PeCO2 = expired air CO2
103
thyroid scans
The combination of hyperthyroid symptoms, blood results, and patchy uptake on nuclear scintigraphy point towards a diagnosis of toxic multinodular goitre.
In Graves disease, scintigraphy would show diffuse enlargement of both thyroid lobes, with uniform uptake throughout.
A solitary adenoma would present similarly to toxic multinodular goitre, but you would expect nuclear scintigraphy to show a small focus of uptake.
104
tricyclic overdose management
IV bicarbonate
first-line therapy for hypotension or arrhythmias
indications include widening of the QRS interval >100 msec or a ventricular arrhythmia
other drugs for arrhythmias
+ class 1a (e.g. quinidine) and class Ic antiarrhythmics (e.g. Flecainide) are contraindicated as they prolong depolarisation
class III drugs such as amiodarone should also be avoided as they prolong the QT interval
response to lignocaine is variable and it should be emphasized that correction of acidosis is the first line in the management of tricyclic-induced arrhythmias
intravenous lipid emulsion is increasingly used to bind free drug and reduce toxicity
dialysis is ineffective in removing tricyclics
105
ITP bone marrow exam
increased megakaryocytes
106
metastatic bone pain mx
analgesia
bisphosphonates
radiotherapy
107
prophylaxis for contacts of patients with meningococcal meningitis
oral ciprofloxacin or rifampicin
108
most common and severe form of renal disease in SLE patients
diffuse proliferative GN
109
renal tubular acidosis causes metabolic acidosis with
normal anion gap
110
painful third nerve palsy
PCA aneurysm
111
CLL investigation of choice
immunophenotyping (will demonstrate Bcells CD19 positive)
112
Flecainide MOA
blocking the Nav1.5 sodium channels in the heart
113
SGLT2 inhibitors site of action
early PCT
114
most specific ECG finding in acute pericarditis
PR depression
115
nephrotic syndrome + malignancy
membranous glomerulonephritis
lymphomas cause MCD
116
AML good prognosis
t15:17 APML
117
NAFLD, next investigation
enhanced liver fibrosis blood test
118
causes of rapidly progressive glomerulonephritis
Goodpastures
ANCA
119
MEN2B
medullary cancer, phaeo, marfan
When differentiating between MEN 2A and 2B, it is worth remembering that MEN 2B has similar characteristics as MEN 2A (Thyroid carcinoma's, Adrenal tumours, Parathyroid hyperplasia) but in addition typically have a Marfanoid appearance and mucosal neuromas, as well as the absence of hyperparathyroidism.
MEN type 1 is characterised by pancreatic neuroendocrine tumours, pituitary adenoma and parathyroid hyperplasia.
120
ABPA treatment
systemic glucocorticoid
oral antifungals adjunct
121
disproportionate microcytic anaemia with raised HbA2
beta thalassaemia trait
122
CLL treatment
FCR
123
PBC
IgM
antimitochondrial antibodies, M2 subtypes
middle aged females
sicca syndrome
124
prolactin release is
inhibited by dopamine
upregulated by TRH and oestrogen
inhibitS GnRH and LH
125
Brown-sequard syndrome
Contralateral loss of temperature, ipsilateral loss of fine touch and vibration, ipsilateral spastic paresis
The spinothalamic tract decussates at the same level the nerve root enters the spinal cord. The corticospinal tract, dorsal column medial lemniscus, and spinocerebellar tracts decussate at the medulla
126
PCT diagnosis
urine uroporphyrinogen
127
serum and urine porphobilinogen
AIP
128
eosinophilia and mononeuritis multiplex after starting new med for asthma
monteleukast can unmask churg-strauss
129
management of HACE and HAPE
Management of HACE -
descent
dexamethasone
Management of HAPE -
descent
nifedipine, dexamethasone, acetazolamide, phosphodiesterase type V inhibitors*
oxygen if available
130
troponin binding
I to actin
T to tropomyosin
C to calcium ions
131
drugs which exhibit zero order kinetics
phenytoin
alcohol
salicylates
132
FISH
uses fluorescent DNA or RNA probe to bind to specific gene site of interest for direct visualisation of chromosomal anomalies
133
causes of drug-induced photosensitivity
thiazides
tetracyclines, sulphonamides, ciprofloxacin
amiodarone
NSAIDs e.g. piroxicam
psoralens
sulphonylureas
134
severe alcoholic hepatitis
steroids
135
anal fissure management
Management of an acute anal fissure (< 1 week)
soften stool
dietary advice: high-fibre diet with high fluid intake
bulk-forming laxatives are first-line - if not tolerated then lactulose should be tried
lubricants such as petroleum jelly may be tried before defecation
topical anaesthetics
analgesia
Management of a chronic anal fissure
the above techniques should be continued
topical glyceryl trinitrate (GTN) is first-line treatment for a chronic anal fissure
if topical GTN is not effective after 8 weeks then secondary care referral should be considered for surgery (sphincterotomy) or botulinum toxin
136
SIADH underlying mechanism causing hyponatraemia
Antidiuretic hormone promotes water reabsorption by the insertion of aquaporin-2 channels
137
pseudoxanthoma elasticum
autosomal recessive
retinal angioid streaks
'plucked chicken skin' appearance - small yellow papules on the neck, antecubital fossa and axillae
cardiac: mitral valve prolapse, increased risk of ischaemic heart disease
gastrointestinal haemorrhage
138
cryptosporidium diagnosis
Ziehl-neelsen modified staining of stool
139
evolving pattern of lesions of individual nerves, pain (ful sensory loss)
MM
PAN can cause
140
prominent V waves on JVP
tricuspid regurg
141
cannon A waves
CHB and atrial flutter
142
absent A waves
atrial fibrillation
143
slow Y descent
tricuspid stenosis or cardiac tamponade
144
exaggerated X descent
constrictive pericarditis
145
prognosis in pancreatitis
PANCREAS
PaO2 <8
Age >55
Neutrophilia
Calcium <2
Renal - urea >16
enzymes; LDH and AST
Albumin <32
Sugar - glucose >10
146
anti-NMDA receptor encephalitis
associated with ovarian teratoma
psychiatric symptoms, seizures, autonomic instability
147
hepatitis is associated with which cryoglobulinaemia
mixed T2
148
type 1 cryoglobulinaemia
lymphoproliferative disorders with immunology demonstrating presence of monoclonal IgG or M
RAYNAUDS
149
marbled appearance of bone
osteopetrosis
normal Ca, phosph, ALP and PTH
Osteitis fibrosa cystica - replacement of bone mass with fibrosis and development of brown tumours. Patients have raised ALP, raised calcium, raised PTH and low phosphate.
Osteomalacia - low calcium and low phosphate with increased ALP and increased PTH.
Osteogenesis imperfecta type 3 - disorder of collagen formation leading to brittle bone, bone deformities and blue sclera amongst other features.
Osteopetrosis - normal calcium, phosphate, ALP and PTH levels.
Paget's disease - calcium, phosphate and PTH unaffected with ALP raised.
150
disseminated gonococcal infection triad
tenosynovitis
migratory polyarthritis
dermatitis
151
oxygen dissoc curve left shift (lower o2 delivery)
Low [H+] (alkali)
Low pCO2
Low 2,3-DPG
Low temperature
152
oxygen dissoc curve R shift (raised O2 delivery)
Raised [H+] (acidic)
Raised pCO2
Raised 2,3-DPG
Raised temperature
153
electrolyte imbalance potentiating digoxin toxicity
lower potassium levels lead to higher levels of digoxin binding to the ATPase pump
154
paracetamol overdose occurs when glutathione stores run out leading to
an increase in NAPQI (n actely p benzoquinone imine)
155
whipple's disease
diarrhoea, weight loss, arthralgia, lymphadenopathy, ophthalmoplegia
156
how does alcohol binging lead to polyuria
inhibition of posterior pituitary gland
157
subacute combined degeneration of the cord
loss of proprioception and vibration sense (dorsal columns) + lateral columns are also affected and would cause spasticity and brisk knee reflexes. Babinski sign is typically positive
158
genetic cause of nephrogenic DI
vasopressin receptor
aquaporin 2 channel
159
familial mediterranean fever
autosomal recessive, hereditary inflammatory disorder characterised by reoccurring episodes of abdominal pain, fever, arthralgia, and chest pain
160
warfarin management of high INR
Major bleeding (e.g. variceal haemorrhage, intracranial haemorrhage) -
Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*
INR > 8.0 + Minor bleeding -
Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0
INR > 8.0 + No bleeding -
Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0
INR 5.0-8.0 + Minor bleeding -
Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0
INR 5.0-8.0 + No bleeding -
Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose
161
de clerambaults
famous in love
162
in a patient with hypercalciuria and renal stones
give thiazide diuretics
usually cause hypercalc, but not in urine
163
rifampicin MOA
inhibits RNA synthesis
164
penicillins, cephalosporins and carbapenems MOA
cell wall synthesis - peptidoglycan cross-linking
165
glycopeptides (vanc) MOA
cell wall synthesis - peptidoglycan synthesis
166
quinolones MOA
inhibit DNA topoisomerase
167
metronidazole MOA
damages DNA
168
trimethoprim MOA
dihydrofolate reductases
169
sulfonamides MOA
dihyrdopteroate synthase
170
aminoglycosides and tetracyclines MOA
protein synthesis - 30S
171
macrolides, chloramphenicol, clindamycin, linezolid, streptogrammins MOA
protein synthesis - 50S
172
tolbutamide drug class
sulfonylureas
173
hypnagogic jerks occur during
nREM1
REM - lucid dreaming and the absence of the normal atonia
174
metabolic ketoacidosis with normal or low glucose
think alcoholic ketoacidosis
175
angular cheilitis
vitamin B2 riboflavin deficiency
176
thyrotoxic storm treatment
Bb, PTU and hydrocort
177
overuse of NaCl
hyperchloraemic metabolic acidosis
178
Budd Chiari syndrome triad
abdo pain
ascites -> distension
tender hepatomegaly
USS with doppler flow studies
179
Paget's disease biochemical marker
urine hydroxyproline
180
expressivity describes
the extent to which a genotype shows its phenotypic expression in an individual
181
relapsing polychondritis
ear problems, nasal chondritis, respiratory tract involvement, arthralgia
182
blood group A is associated with increased risk of
gastric cancer
183
pancreatic cancer sign
double duct
184
LMWH MOA
activation of AT3
185
Cushings VBG
hypokalaemic metabolic alkalosis
186
Addisons VBG
hyperkalaemic metabolic acidosis
187
aminoglycoside toxicity is secondary to
acute tubular necrosis
188
what is protective in paracetamol OD
acute alcohol intake
189
adhesive capsulitis which movement most affected
ext rot
190
SJS vs TEN
10% vs >30% of BSA
191
Hashimotos increases risk of development of
MALT lymphoma
192
Horners syndrome
First-order - where the lesion is central, occurring anywhere from the hypothalamus, through the midbrain to the synapse at T1.
head, arm, trunk = central lesion: stroke, syringomyelia
Second-order - where the lesion is between the synapse in the spinal cord to the superior cervical ganglion.
just face = pre-ganglionic lesion: Pancoast's, cervical rib
Third-order - where the lesion is post-ganglionic occurring anywhere above the superior cervical ganglion.
absent = post-ganglionic lesion: carotid artery
193
where is phosphate reabsorbed
proximal tubule
194
Fabry's disease inheritance
XLR
195
what class of receptors does adrenaline work on
GPCR
196
pilocarpine drug class
musc agonist
197
microscopic colitis
chronic diarrhoea
colonoscopy and biopsy
Microscopic colitis typically presents with persistent watery diarrhoea. Colonoscopy plus random colonic biopsies are essential for the definitive diagnosis of microscopic colitis. The colon often appears macroscopically normal, with biopsies showing a mononuclear cell infiltration of the lamina propria with either a thickened subepithelial collagen band (in collagenous colitis) or intraepithelial cell lymphocytosis (in lymphocytic colitis). Proton-pump inhibitors, and in particular, lansoprazole, are associated with the development of microscopic colitis, making this the best answer.
198
systemic mastocytosis
abdo pain, flushing, urticaria pigmentosa - urinary histamine
199
myoclonic seizures
valproate first line for males
females - levetiracetam
200
methaemoglobinaemia treatment
if congenital - IV ascorbic acid
if not - methylene blue
201
which molecule is added to the enzyme by the golgi apparatus to tag it for transport to the lysosome
mannose 6-phosphate
202
SJS drug causes
lamotrigine
phenytoin
carbamazepine
203
publication bias diagram
funnel plots
204
when starting SSRI in someone on NSAID
give PPI
205
liver transplant criteria
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
206
which blood tests monitor haemochromatosis
ferritin and transferrin saturation
207
causes of restrictive lung disease
Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity
208
causes of obstructive lung disease
asthma
COPD
bronchiectasis
bronchiolitis obliterans
209
alpha 1 antitrypsin genotypes
normal: PiMM
heterozygous: PiMZ
evidence base is conflicting re: risk of emphsema
however, if non-smoker low risk of developing emphsema but may pass on A1AT gene to children
homozygous PiSS: 50% normal A1AT levels
homozygous PiZZ: 10% normal A1AT levels (MANIFEST DISEASE)
210
bone pain, tenderness and proximal myopathy (waddline gait)
osteomalacia
D3 supplementation
211
NIV works in range
7.25-35
212
pentad of TTP
fever
neurological dysfunction
evidence of haemolysis on blood film
renal injury
thrombocytopaenia
An acquired inhibition of ADAMTS13, preventing the cleavage of von Willebrand Factor multimers
213
prolapsed disc
L3 nerve root compression -
Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
L4 nerve root compression -
Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
L5 nerve root compression -
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
S1 nerve root compression -
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
214
terbinafine MOA
inhibits squalene epoxidase
215
griseofulvin MOA
interacts with microtubulues to disrupt mitotic spindle
216
amphoB MOA
binds with ergosterol forming a transmembrane channel
217
flucytosine MOA
converted by cytosine deaminase to 5-fluorouracil, which inhibits thymidylate synthase and disrupts fungal protein synthesis
218
caspofungin MOA
inhibits synthesis of beta-glucan
219
metformin MOA
activation of AMPK
220
PSC choice investigation
ERCP/MRCP
221
syringomyelia affects which spinal cord structure
compression of the spinothalamic tract fibres decussating in the anterior white commissure of the spine
222
Japanese encephalitis
Clinical features of Japanese encephalitis are headache, fever, seizures. Parkinsonian features indicate basal ganglia involvement.
223
common complication of plasma exchange
hypocalcaemia
due to citrate use
224
cisplatin electrolyte disturbance
hypomagnesaemia
225
polychromatic macrocytes what type of cell
reticulocytes
have a mesh-like (reticular) network of ribosomal RNA that is visible when stained. This is not present in mature erythrocytes
226
matching HLA in transplant, importance
DR > B > A
227
tolvaptan drug class
VP receptor 2 antagonist
used for ADPKD
228
Hodgkins lymphoma receive which blood product
irradiated packed red cells - avoid gvhd
229
PBC management
first-line: ursodeoxycholic acid
slows disease progression and improves symptoms
pruritus: cholestyramine
fat-soluble vitamin supplementation
liver transplantation
e.g. if bilirubin > 100 (PBC is a major indication)
recurrence in graft can occur but is not usually a problem
230
campylobacter treatment
clarithromycin
cipro 2nd
231
majority of glucose reabsorption in the nephron occurs within
PCT
232
in gestational diabetes if already on metformin
add insulin
233
codeine to morphine conversion
divide by 10
234
organophosphate poisoning
Medical management of organophosphate poisoning involves resuscitation, critical care and airway maintenance, and administration of atropine.
235
dermatomyositis antibodies
ANA most common
anti mi 2 most specific
236
polymyositis antibodies
anti jo1
237
atherosclerosis stages
(1) Endothelial dysfunction is the initial stage - triggered by risk factors - resulting in a pro-inflammatory, pro-oxidant, proliferative state.
(2) This allows for the fatty infiltration of the subendothelial space by low-density lipoprotein (LDL) particles.
(3) Leukocytes are recruited to the site of development due proinflammatory cytokines, which are partly maintained by LDL.
(4) Over time, these phagocytose LDLs and other lipoproteins, becoming foam cells which contribute to the overall structure of the plaque.
(5) Smooth muscle cell proliferation and migration is the final step in the formation of atheroma, leading to the development of a fibrous capsule over the fatty plaque.
238
Marfanoid features, learning difficulties, downward lens dislocation, myopia, malar flush
homocystinuria
treatment is pyridoxine - vitamin B6
239
lithium desensitises the kidney's ability to respond to ADH in the
collecting ducts
240
drug causes of urticaria
aspirin
penicillins
NSAIDs
opiates
241
sulfonylureas MOA
Binds to and shuts pancreatic beta cell ATP-dependent K+ channels, causing membrane depolarisation and increased insulin exocytosis
242
mixed connective tissue disease antibody
anti-ribonuclear protein antibodies
243
strongyloides treatment
ivermectin and bendazoles
244
levothyroxine acts via
nuclear receptors
245
why does haptoglobin fall in G6PD
binds to free Hb
246
variable intensity of S1 is caused by
CHB
247
screening for hereditary angioedema BETWEEN attacks
C4
248
coved ST elevation followed by negative T wave
Brugada
249
if ICD causing ventricular arrhythmias in Brugada
quinidine
250
unmasking ECG abnormalities of Brugada
flecainide
251
angiodysplasia with aortic stenosis cause
acquired VWD
angiodysplasia due to alteration in the pulse waveform and hypoxia
252
gas gangrene due to clostridium perfringens infection
clindamycin and metronidazole
253
mixed respiratory and metabolic acidosis
CO2 raised
bicarb below the lower limit of normal
acidosis
254
posterior cerebral artery stroke visual
contralateral homonymous hemianopia (usually with macular sparing)
255
pulmonary haemorrhage + renal impairment
anti GBM disease
plasma exchange is intervention of choice
256
phase 0 of cardiac action potential
phase 2
sodium ion influx
L and T type calcium channels
phase 3 - potassium efflux
257
Barrett's with low grade dysplasia for the first time
surveillance endoscopy with 6 month repeat
if seen again -> RFA
258
HF with symptoms and persistent increased pulse rate
ivabradine
259
primary function of microRNAs
silencing of messenger RNA preventing ribosomal binding and protein translation
260
dipyridamole moa
adenosine uptake inhibitor
261
LVF with low ejection fraction and episodes of recurrent VT
ICD - due to significant arrest risk
262
IV quinine therapy SE
hypoglycaemia
malaria -> hyperkalaemia, hypocalcaemia, hyponatraemia
263
short QT interval
hypercalcaemia
hyperkalaemia
hyperthermia
metabolic acidosis
264
Katayama fever tx
corticosteroids
265
pseudohypoparathyroidism
borderline low serum Ca and phosphate at upper limit of normal
GPCR mutation -> parathyroid hormone resistance
266
omeprazole electrolyte disturbance
hypomagnesaemia
267
most likely ab to be positive in systemic sclerosis
ANA
268
benzbromarone moa
URAT-1 inhibitor -> increases excretion of uric acid by blocking reabsorption
269
COL4A3/4/5
Alport
270
HNF1a/b
MODY3/5
271
PNPLA3
NASH
272
latent tb rx
3 months of iso+rif or 6 months of iso with pyridoxine
273
painful arc
subacromial impingement
274
posterior MI
most often PDA (90% of patients)
275
del(13q) vs (17q)
good prog vs poor in CLL
276
slow growing brain tumour - months of raised ICP
ependymoma
277
Waldenstroms mx
rituximab based chemo (eg with bendamustine)
278
evidence of pulmonary htn, RHF and increase in O2 sat between the RA and the RV
VSD
279
which organ drives most of the response to hypoxia
carotid body
280
injury to dominant temporal lobe causes
receptive aphasia, dyslexia, impaired verbal memory and word agnosia, complex hallucinations and contralateral homonymous upper quadrantanopia
281
how does aspirin prevent platelet aggregation
reduced production of TXA2
is a COX1 inhibitor
282
what drives the initial generation of an action potential within muscle cells
sodium influx
283
why does ACEI cause rise in creatinine
efferent renal arteriolar dilatation
284
which infections occur with much greater frequency in CVID
giardiasis
prone to Hib, s pneum, morax, s aureus, PCP, myco
285
progressive IgA nephropathy despite controlled BP, full dose ACEI and high dose oral pred
cyclophosphamide and azathioprine
286
proximal myopathy, abdominal adiposity
IGF1 - GH deficiency
287
medial medullary syndrome - vertebral artery occlusion
R limb weakness and loss of fine touch and proprio
facial sens normal (trigeminal nucleus spared)
288
pituitary apoplexy most important hormone to replace first
cortisol
289
small bowel diarrhoea - large volume watery in HIV
microsporidia or salmonella
colonoscopy with ileal intubation
290
delta waves on ECG
WPW
291
hereditary spherocytosis with RUQ pain
haemolysis (spectrin and ankyrin deficiency) -> gallstones
292
dull RUQ pain + portal htn + ascites
Budd Chiari syndrome
293
JME mx
levetiracetam
294
in pregnancy switch bosentan for
sildenafil
295
tx of sight threatening macular oedema
focal photocoagulation
296
lowest level of cortisol
0000
297
myocardial ischaemia on bg of chronic cocaine abuse
ST depression -> coronary artery spasm
GTN infusion or CCB
298
AF in pregnancy
avoid thiazide diuretics
metoprolol over bisoprolol
nitrates are vasodilator of choice, as ACEI/ARB teratogenic
if murmur + AF + HF -> PMV
299
which cells express MHC class 2 antigens
dendritic cells
300
chlamydia in pregnancy
azithromycin 1g
301
primary mode of action of cyclophosphamide
T cell modulation
302
adalimumab moa
TNF inhibitor
303
denosumab
teriparatide
6 monthly SC injection
daily injection
304
non-parametric 2 independent groups of samples
WRS
305
ambrisentan vs bosentan
endothelin A only
vs both (non-sel)
306
MODY abs?
HNF1a
none
very sensitive to sulfonylureas
307
failure of 2 DMARDs in psoriatic arthropathy
TNF antagonist - golimumab
ustekinumab IL12/23 after
MTX first as DMARD
308
flaccid bullae leaking straw-coloured fluid and healing with erythematous base
bullous impetigo - Staph Aureus
mupirocin and fusidic acid
309
PSM
pulsatile hepatomegaly
heave
TR
310
UGT1A1 gene
Gilberts syndrome
311
chlamydia tx
doxy BD 7d
312
GN in GPA
pauci-immune crescentic glomerulonephritis
313
crescentic glomerulonephritis with linear IgG deposition
antiGBM
314
osteomyelitis due to mixed organism (hx of diabetes mellitus)
vanc + ceft 4-6 weeks
315
post angiography skin changes, eosinophilia, raised CRP and acute renal failure
cholesterol emboli
supportive therapy only
316
Turners karyotype
XO
317
Klinefelter karyotype
XXY
318
AIS
XY karyotype
319
sequential vs continuous combined HRT
if < year -> sequential
320
diagnosis of polymyositis
EMG and muscle biopsy
steroids -> mx
321
confirmation of B thal trait
Hb electrophoresis
322
hyperkalaemic metabolic acidosis worsened with introduction of ACEI
RTA t4 (deficiency of aldosterone action) caused by DM, SLE, amyloid, chronic tubulointerstitial disease
323
section 5.2
doctor to detain 72 hours
324
5.4
psych nurse to detain for 6 hours
325
section 2
compulsory detain for assessment
326
section 3
admission for treatment
327
section 7
guardianship
328
when does gvhd happen in transfusion
when non irradiated transfusions are given to pt with underlying haematological malignancy
329
ST elev in leads 2,3,avf
RCA
330
gonorrhoea with penicillin allergy
single high dose 2g azithro
331
Legionella
levofloxacin or azithromycin
332
JAK2 V617F is present in 45-68% of patients with
myelofibrosis
333
creatinine rise with trimethoprim
reversibly inhibits renal tubular secretion of creatinine - independent of gfr which remains same
334
pubic lice
malation/permethrin
335
CYP3A4 inhibitors which can increase tacrolimus levels leading to toxicity
fluconazole
336
TBMN
AD due to collagen formation defect
familial haematuria
337
LGV treatment
doxy bd for 21d
338
recurrent microscopic haematuria
renal impairment
renal colic
multiple areas of medullary calcification on AXR
medullary sponge kidney
increase fluid intake -> citrate
339
340
single thyroid nodule hot
tx dose radioiodine
341
polyuria
polydipsia
postural drop in BP on standing
low osm and elevated urine sodium excretion
nephrogen DI drug induced
ofloxacin
342
agitated with a CNS stimulant
IM lorazepam and haloperidol
343
chemo for MALToma
imatinib and rituximab
344
TZD site of action
DCT
345
ipsilateral Horners and nystagmus in affected direction
contralateral loss of pain and temp sensation in limbs
PICA
346
nephron normally impermeable to water
ascending limb of LOH
347
increased transaminases in hep A or E
hepatocyte necrosis
348
systemic amyloidosis in bronchiectasis
related to chronic inflammation
progressive protein leak in kidneys and peripheral oedema
cardiac? MRI
349
asthma sinusitis mononeuritis and eosinophilia
EGPA
350
AF during a period of ischaemia
aspirin, clopi, apixaban
351
blister heals with hyperpigmentation and hypertrichosis
elevated transaminase and ferritin
PCT
352
which features on ECG are supportive of VT compared to SVT with aberrant conduction
negative concordance across chest leads
RSR with taller L R wave
extreme axis deviation (northwest)
absence of typical R or L BBB
broad QRS >160
353
2 main ketones produced by the liver
acetoacetate -> falls slowly
BHB
354
SLE renal failure despite hcq
MMF
safer than cyclopshoph due to lower risk of ovarian failure
then cyclo then aza
355
likely DVT, low Sats, possible PE + symptoms of an acute stroke
paradoxical embolism as cause of stroke
due to undiagnosed PFO
bubble contrast echo!
356
a1at heterozygote
PiMZ
357
GBM immunosuppressant of choice
cyclophosphamide
358
which ECG finding is the strongest indication for PPM insertion
RBBB and LAFB
359
where does ostium of coronary sinus drain
R atrium
360
asthma - acidosis with CO2 retention and hypoxia, pH >7.26 and acidotic despite one hour of therapy
NIPPV
361
distal vs proximal segment of the ACA
proximal less likely to result on neuro seq due to collateral
362
common peroneal nerve palsy in RA
due to nerve entrapment due to deformity
363
glycogen storage disorders
Von Gierke's - G6P - hepatic glycogen accumulation - hypoglycaemia, lactic acidosis, hepatomegaly
Pompe's disease - LA14G - cardiomegaly
Cori disease - A16G - muscle hypotonia
McArdles - GP (myophosphorylase) - myalgia, myoglobinuria with exercise
364
lysosomal storage disease
Gauchers - GB - commonest - hsmeg, aseptic femur necrosis
Tay-Sachs - hexosaminidase A - GM2 ganglioside - developmental delay, cherry red spot of the macula, liver and spleen normal
NPD - sphingo - hsmeg ^ else same
Fabry - AGA - agiokeratomas, peripheral neuropathy, renal failure
Krabbe's disease - galactocerebrosidase - per neur, optic atrophy, globoid cells
metachromatic leukodystrophy - demyelination of central and peripheral ns
365
mucopolysaccharidoses
Hurler - gargoylism, hsmeg, corneal clouding
Hunter - coarse facial features, behavioural problems, corneal clouding
366
verapamil + fluconazole
constipation and relative bradycardia
367
gastroenteritis incubation
1-6 hrs: Staphylococcus aureus (vomiting), Bacillus cereus (vomiting within 6 hrs, diarrhoea after)*
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis
bloody - shigella, amoebiasis, campy
368
VHL
haemangioblastoma
phaeo
renal cysts/ca
369
choroidal haemangioma assoc with
sturge weber syndrome
370
ciclosporin moa
IL2 production inhibition
371
which pituitary hormone is under constant inhibition
prolactin from dopamine
ACTH is pulsatile with half life 10 minutes - control of CRH - under negative feedback
ADH - secretion increases in response to hypovolaemia and/or increased osmolality
LH - cyclical
TSH - circadian and pulsatile
372
anti-PR3 antibodies
GPA
373
S mansoni
hepatic fibrosis
374
low platelets
low fibrinogen
elevated PT and APTT
elevated D dimer
DIC
375
short stature
chronic muscle pain and weakness
normal renal function
hypocalcaemia
hyperphosph
low PTH
congenital hypoparathyroidism
376
anaemia
low albumin
low calcium
diarrhoea
previous surgical procedures
short bowel syndrome
377
7th nerve palsy with loss of sensation - where is lesion
before emerges from stylomastoid foramen
378
chronic hypoxia compensatory changes
increased haematocrit
positive dip is from running - march haemolysis
379
mitral stenosis with AF in pregnancy
BB such as bisop
380
how does alcohol cause hypoglycaemia
increased first phase insulin response
381
slowly progressive heart failure and AF, gradual proximal muscle weakness
telomere shortening in muscle stem cells - Duchenne/Beckers - inability to regenerate new muscle
382
Behcets mx
pred
azathioprine
colchicine an option if unable to take pred and severe genital ulcer
cyclophosphamide only in large artery vasc or posterior uveitis
383
drugs causing serotonin syndrome
MAOI
SSRI
ecstasy
amphetamines
384
referral for parathyroidectomy
no other chronic illness
385
platelet infections
staph epidermidis
bacillus cereus
386
in stent thrombosis
first 30 days
ST elevation in same territory after stopping clopi
387
tall and thin with a soft diastolic murmur in the L upper sternal edge, pitting oedema ankles
pulmonary regurg
388
IgG defiency
G1 - hypogammaglobulinaemia
makes up 2/3rds of total IgG
vaccination essential
G4 - joint pain and fatigue
G2 - Neisseria, strep and haemophilus
389
false positive quantiferon with negative tuberculin
latent TB need to rule out
390
nitrous oxide causes deficiency of
B12
bilateral loss of vibration and position, upgoing plantars, R optic disc pallor
391
which is the 1y mode of action of digoxin
intracellular sodium accumulation
392
MCD - previous response to high dose pred
pred again
ACEI?
393
diphtheria tx
macrolides and penicillins
394
amaurosis fugax occlusion
atheroma within ipsilateral internal carotid
395
weakness of flexion of terminal phalanx of the thumb
median nerve
396
campylobacter
macrolides
397
best initial investigation for detecting early rheumatoid joint changes
colour doppler ultrasound
398
APL abs
cardiolipin
399
best marker for assessing disease activity
complement C3 levels
400
poor prognosis in PPH
elevated BNP
reduced RV EF
SV arrhythmias
elevated hepatoma derived GF
male
elevated R atrial pressure
development of AFib
401
after 5 shocks and pulseless VT
amiodarone 150
if 300 given after 3rd shock
402
PSC most appropriate ix
MRCP as non invasive
403
phosphate reabsorption
PCT
404
acute rejection timing
<6 mo
405
leading cause of ESRF in developed countries
diabetic nephropathy
406
osmosis definition
passage of solvent towards a higher concentration of solute across a semi-permeable membrane
407
CLL fludarabine presenting with worsening anaemia symptomatic
AIHA, due to increased imbalance in Treg function from fludarabine. Tx with pred
408
T1 lesion
weakness and wasting of the intrinsic muscles of the hand and the interossei, areas of sensory loss corresponding to the T1 dermatome
409
systemic vascular resistance on standing
increases
SV decreases
CVP falls
HR increases
venous compliance decreases
410
amphetamine psychosis tx
benzos
411
frontotemporal dementia tx
SSRIs
412
SO4LR6
cn
413
bacterial sepsis and neutropenia (related to carbimazole)
GCSF 4-10microgram/kg/d
414
ramipril in pregnancy
stop - switch to labetalol or methyldopa
415
cytokines produced by th2 cells
IL4
416
renal impairment + haemolytic anaemia working on a farm
E coli - HUS
antiplatelets, FFP, anticoag, eculizumab
417
azathioprine and gout
avoid xanthine oxidase inhibitors - eg febuxostat -> BM supp
418
HLA for takayasu
B52
419
Tourette tx
risperidone
420
chlorthalidone site of action
DCT
421
low GCS, low BP, sinus tachy and BL pupil dilatation
ECG - QRS widening with 110ms duration
pH 7.21
TCA overdose - QRS>100 -> sodium bicarb reverses the Na channel blockade
422
strongy tx
ivermectin/albendazole
423
idiopathic membranous nephropathy with worsening proteinuria and renal function + pitting oedema
pred + cyclophos
424
monoclonal ab for thyroid eye disease
rituximab
ciclosporin
425
SIBO tx
rifaximin
metro/tetra
426
commonest cause of transfusion related morbidity in the UK
TACO
427
when are anti TNF agent stopped in pregnancy
16 weeks
428
birch fruit syndrome tx
oral antihistamine
429
Holmes Adie pupil where is the damage
parasympathetic ciliary ganglion
430
paraffin ointment advice
no smoking
431
fulminant UC - to avoid surgery
cyclosporine
432
seminomas most likely to be elevated
LDH
433
pulsus paradoxus
exaggerated fall in BP on inspiration
434
dystrophia myotonica type 1
progressive weakness, foot drop, weakness of LPS and temporalis, weak sternocleidomastroics and intrinsic muscles + muscles of forearm + high arched palate
435
HSP
lower limb muscle weakness and foot drop
436
DM2
neck and finger flexors, difficulty getting up from chair or climbing stairs
437
HSAN
1 - peripheral neuropathy, ulceration
2 - same
438
oligoarthritis, intermittent fevers, hepatomegaly with -ve RF
adult onset Still's disease
anakinra (IL1)
439
ST depression in V1-3 with dominant R in V2
PDA - RCA
440
paraneoplastic cerebellar degeneration
bronchial small cell cancer
anti Hu abs
if women with breast/ovarian then antiYo
441
muscle for standing without falling
soleus
442
cisplatin heart
AF (due to Mg changes)
443
pemphigus vulgaris non responsive to pred and aza
IV rituximab
444
strongest pointer of worsening mitral valve stenosis
haemoptysis
445
HHR inheritance
XLD
446
what causes hyperphosphataemia in chronic renal failure
decreased functioning renal tissue
447
purpuric rash affecting lower limbs, raised Cr and urine +ve for blood and protein
Hep C (cryoglob)
448
mycophenolate =
tremor
449
INO
diplopia in other direction to affect MLF
450
skin infection with pen allergy
clindamycin
451
SBP
significant - piptaz
452
hereditary amyloidosis
TTA
453
metastatic prostate ca resistant to first line anti-androgen therapies
enzalutamide
454
familial hypercholesterolaemia on statin and ezetimibe, chol 7.2
evolocumab
455
recent stay in hospital with ?staph infection
cover MRSA
linezolid
456
aciclovir moa
DNA polymerase inhibitor
457
Marfan sx bp management
ACEI or BB
458
acute interstitial nephritis - drop in Cr, peripheral eosiniphilia, proteinuria with white and red blood cells
aciclovir
459
moderate-severe diabetic foot infection
IV co-amox
460
cystinuria mx
hydration
D penicillamine
461
strongest indication for surgery in endocarditis
episodes of complete heart block
462
low K, high BP despite max ACEI, metabolic alkalosis
Conns - hyporeninaemic hyperaldosteronism
463
which is a primary feature of hyperglucagonaemia
gluconeogenesis
464
aquaporin type in CD
2
465
buprenorphine receptor
partial mu opioid agonist
466
Pelger-Huet anomaly
bilobed nuclei in neutrophils, skeletal abnormalities
467
pericarditis mx
NSAID first
then colchicine
468
dorsal interossei nerve root
C8/T1
469
dorsal scapular nerve - weakness of rhomboid and levator scapulae
C4/5
470
long thoracic, phrenic, suprascapular and lateral pectoral nerve
C5/6
470
C6/7 nerve root injury
sensory supply to hand (radial)
471
C7/8 nerve root lesion
radial injury
472
hypertension resistant to antihypertensives, low potassium
hyporeninaemic hyperaldosteronism
473
GBS mx
IVIG/pex
474
anti ampiphysin antibodies
stiff person syndrome and encephalomyelitis - breast and lung ca
475
anti zic 4 antibodies
cerebellar degeneration, SCLC
476
mab for PMR
tocilizumab
477
MODY
HNF-1a gene
sulphonylureas
478
greater curvature of stomach primary blood supply
L gastroepiploic
479
Factor V Leiden background
long term anticoag needed
480
aflibercept
VEGF - ARMD
481
denosumab moa
RANKL inhibitor - nuclear factor kappa B
482
sildenafil moa
PDE5
483
MODY symptoms but pancreatic atrophy and formation of renal cysts
HNF-1b instead of a
also epididymal cysts and bicornuate uterus etc
484
tennis elbow muscle pain
extensor carpi radialis brevis
485
golfers elbow muscles
flexor carpi ulnaris
486
alternative to thalidomide
bortezomib
proteasome inhibitor
inhibits proteins which govern cell cycle progression and NF kappa B activation leading to cell cycle arrest and apoptosis
487
ezetimibe moa
NPC1L1 inhibitor
sterol transporter
reduces cholesterol absorption from the gut
488
hypophosphataemic rickets inheritance
X linked dominant
PHEX gene - regulates FGF-23 which regulates hydroxylation of vit D and renal PO4 reabsorption
489
renovator with acidosis and hypophosphataemia - osteomalacia symptoms and bloods
proximal RTA - lead poisoning
490
primary CNS lymphoma assoc infection
EBV
491
roflumilast
PDE4 inhibitor - if fail to gain control of COPD on triple inhaled therapy
elevated cAMP levels and mitigates COPD related malfunction of leukocytes etc
492
PSC mx
UDO
493
recurrent sinopulmonary or gastrointestinal infections
IgA deficiency
494
MG not responding to pred or pyridostigmine
azathioprine
495
AD inherited T2DM - normal BMI at diagnosis and long-term control with diet alone
glucokinase mutation
496
SLE worse despite hcq and steroids
belimumab - inhibits BLyS receptor -> downreg B lymphocyte activity
497
IIH with worsening of headache, papilloedema, D dimer raised
venous sinus thrombosis
do an MRV
at high risk
498
penicillin allergy gonorrhoea
azithromycin
499
abx not recommended in pregnancy
ciprofloxacin
500
CRAO treatment
intra-arterial thrombolysis
501
bradycardia and complete HB with very low BP
transvenous pacing
502
obeticholic acid moa
Farnesoid-X-receptor
leads to itching
503
yersinia enterocolitica treatment
quinolones
co-trimoxazole
tetracyclines
504
Graves in pregnancy
PTU in early preg
carbimazole later
NO block and replace!
505
hypotension/normotension, hypokalaemia, alkalosis, increased renin, low urinary Ca
Gitelmans syndrome
506
lack of blinding can affect
type 1 error
false positive - incorrectly rejecting the null hypothesis
507
NASH, unable to lose weight
liraglutide
508
which medication should be avoided in gout with urate renal stones
lesinurad - URAT1 and OAT4 inhibition -> increased excretion of uric acid -> formation of new stones
509
hypotension assoc with MI
reduced urine output
increased creatinine
increased urinary Na
ATN
510
herpes in pregnanc
prophylactic aciclovir from 36 weeks onwards
511
bilateral renal artery atheroma, with pulmonary oedema
amlodipine
stenting reserved for prog inc in Cr despite adequate BP control
512
severe asthma raised eo and not responsive to therapy
mepolizumab
513
omalizumab
IgE neutralising - SC for very atopic
514
reverse transcriptase moa
generates cDNA from an RNA template
515
main effect of 1,25-OH vitamin D
increase absorption of Ca from the GIT during periods when it falls
516
pancytopaenia and evidence of DIC
t15:17 APML
517
differentiation of high vs low median nerve injury
high - both sensory and motor weakness
low - only motor
518
long QT without cardiac arrest
beta blocker
519
metformin primary moa
reduces hepatic glucose output
520
dizziness during exercise stress test
stop
also ataxia or presyncope
521
mushroom farmer fibrosis
EAA
avoid allergen exposure
trichophyton vulgaris and micropolyspora faeni
522
anaemia, coeliac, weight loss + reflux resistant to tx
upper GI endoscopy
increased risk of SCC of oesophagus
523
which vein connect RA to coronary sinus
small cardiac vein
524
warfarin enzyme
vitamin KO reductase (epoxide)
525
RA and preg
azathioprine
526
tinea cruris
jock itch
topical clotrimazole
527
HOCM mutation
myosin-binding protein C
528
VHL inheritance
AD
529
persistent anaemia and abdo discomfort related to splenic enlargement in hereditary spherocytosis
splenectomy
530
fhx of progressive heart failure and neuropathy
familial amyloidosis -> restrictive cardiomyopathy -> biventricular heart failure and elevated JVP rising with inspiration
531
pathophysiology of Grave's orbitopathy
inflammatory infiltration of fat and muscles by lymphocytes etc
build up of water and glycosaminoglycans
532
GPA - failure to respond to steroids and cyclophosphamide
rituximab
533
central weakness, features of systemic infection and an abscess from injecting
wound botulism
metronidazole
penicillin preferred
534
CF diabetes mx
basal bolus insulin and high calorie diet
535
sporadic CJD
rapid neuro deterioration - short term memory loss, movement disorder, myoclonus with dystonia
signal intensity in caudate and putamen
EEG periodic wave complexes
CSF 14-3-3 protein
new variant - younger age, slower progression, psychiatric disorder before memory loss, thalamus signal
536
what does MLH1 code for
DNA mismatch repair gene
537
Hashimoto ab
TPO
538
MODY 5
hnf1b
pancreatic atrophy and renal cysts
539
ankylosing spondylitis - failed 2 different NSAIDs
anti-TNF eg etanercept and adalimumab
540
avoid what in scleroderma renal crisis
prednisolone
541
carbimazole moa
thyroid peroxidase inhibition
542
how do corticosteroids work in thyroid storm
inhibit T4 to T3 conversion
543
long term intervention for MS which is safe in pregnancy
dimethylfumarate
544
GPA mx
IV methylpred and cyclophosphamide
545
Liddle syndrome
AD
distal tubular sodium reabsorption
mutations in genes on chr 16p12 that encode the B and G subunits of the epithelial sodium channel in the collecting duct
546
acute pericarditis viral cause
coxsackie B
547
multiple bowel resections -> renal stones
short bowel syndrome
calcium oxalate stones
548
licorice hypermineralocorticoid effects
11-B-hydroxysteroid dehydrogenase type 2 inhibition
enzyme responsible for inactivating cortisol
549
which is associated with sensescence
cessation of mitosis
550
methaemoglobinaemia pathophys
oxidation of Fe2 to 3+
551
sacubitril valsartan ihibits
neprilysin
552
recurrent respiratory tract infections who has immunoglobulins in normal range
IgG subclass deficiency
553
central retinal haemorrhages
VEGF
photocoag centrally causes macular scarring
554
what drives delayed hypoglycaemia associated with alcohol consumption
reduced gluconeogenesis
555
bitemporal inferior quadrantanopia
Rathke's pouch - suprasellar - craniopharyngioma
556
calorie intake
weight * 22-25
moderate activity x1.5
557
AML good prognosis
Karnofsky score >60%
8:21, 16:16
NPM1 CEBPA mutations
MDR-1 negative phenotype
558
X linked disorder leading to skin rash, osteoporosis, abdo pain, neurological dysfunction
Fabry disease - alpha-galactosidase deficiency
559
ceramidase deficiency
Farber's disease - lysosomal storage
560
galactocerebrocidase deficiency
Krabbe disease
sphingolipidosis
progressive neurological function
561
glucocerebrocidase deficiency
Gaucher's disease
splenomegaly, hepatomegaly, hypersplenism, pancytopenia
562
pioglitazone moa
increases insulin sensitivity in muscle and fat
563
esomeprazole
is the S isomer
564
MRSA resistance mechanism
mutated penicillin binding proteins
565
mycobacterium avium complex tx
ethambutol, rifampicin, azithro/clarithromycin
566
FAP ->
APC gene
up to 1000 polyps by age 20-30
567
imatinib resistance ->
dasatinib
568
hypotension
hyponatraemia
low cortisol
pituitary apoplexy
569
tricyclic OD
sodium bicarb if QRS >100
570
avascular necrosis gold standard
MRI
571
BODE index
BMI
obstruction (FEV1)
distance walked in 6 mins
dyspnoEa assessment
572
lack of efficacy of GTN on top of regular nitrate dosing
tolerance
573
spontaneous bacterial peritonitis with pen allergy
cipro and IV vanc
taz or ceft + metro in non allergic
574
metabolic acidosis
osteomalacia
nephrocalcinosis
RTA1
575
why does methanol od cause blindness
formation of formic acid crystals within optic nerve
acute - hyperaemia
576
where does granisetron work
vagal nerve
CTZ in area postrema
nucleus
nucleus tractus solitaris in brainstem
577
blood in urine in IgA nephro
worse if microscopic vs macroscopic
578
primary site of action of spironolactone
distal portion of distal tubule
579
sickle cell genotypes
SS
SC
AC
580
painless slowly progressive lymphadenopathy with peripheral cyanosis
more likely NHL
HL would be younger age and chest discomfort would be present
581
thermoregulation and circadian rhythm nucleus
anterior hypothalamic
582
lateral preoptic nucleus
nREM sleep
583
paraventricular nucleus of the hypothalamus
osmotic balance - vasopressin and oxytocin
same as supraoptic nucleus of the hypothalamus
584
suprachiasmatic nucleus of the hypothalamus
circadian primary
585
in which population should you increase thyroxine dose slowly
elderly
586
main component of Lewy bodies
alpha synuclein
587
Waldenstroms tx
rituximab based regimen
588
most strongly associated with risk of future CV events
evidence of atherosclerosis affecting more than one vascular bed
589
subclavian line insertion site
1cm inferior to the junction of the middle and medial third of the clavicle
590
optimal way to measure rivaroxaban compliance
PT
591
most common infectious cause of erythema multiforme
HSV
592
mitochondrial disease
DI
DM
OA
D
DIDMOAD syndrome
Lebers optic atrophy
mitochondrial myopathy
Leigh syndrome
593
evolocumab
PCSK9 inhibitor
prevents LDLR degradation
594
aneurysms causing CN3 palsy
ICA
PCA
595
C diff tx
oral vanc
oral vanc and IV metro
rifaximin
596
bendroflumethiazide hypoNa
increased distal tubular sodium loss
597
pneumococcal meningitis
vanc and ceftriaxone
598
elbasvir
HCV NS5A
NS5B - dasabuvir
NS3/4A protease - grazoprevir
599
branches of subclavian artery
vertebral
internal mammary
L common carotid - aorta
Basilar - vertebral
600
benzbromarone inhibits
uric acid reabsorption in the kidney
601
SVCO initial tx
stenting
602
gout IL
IL1
canakinumab
603
varenicline
nicotinic receptor partial agonist
604
moa of Mg in asthma
decreased histamine release
605
ivabradine receptor
If
606
absent gastric bubble on cxr
achalasia
607
reactivation of hsv and pneumonia
S pneum
608
severe refractory colitis
trial of ciclosporin
609
nintedanib moa
tyrosine kinase inhibitor
610
