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MRCP 1 > MRCP 1 > Flashcards

MRCP 1 Flashcards

1
Q

HLA B27

A

Ankylosing splondylosis
Psoriatic arthritis
Reactive arthritis
Acute anterior uveitis

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2
Q

HLA B51

A

Behcet’s

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3
Q

HLA A3

A

Haemochromatosis

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4
Q

HLA DQ2/8

A

Coeliac disease

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5
Q

HLA DR2

A

Narcolepsy
Goodpasture’s

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6
Q

HLA DR3

A

Dermatitis herpetiformis
Sjogren’s
Primary biliary cirrhosis

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7
Q

HLA DR4

A

T1DM
Rheumatoid arthritis (DRB1 gene)

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8
Q

LVEF
Stroke volume

A

Stroke volume/end diastolic LV volume x100
Stroke volume = end diastolic volume - end systolic volume

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9
Q

Cardiac output

A

Stroke volume x heart rate

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10
Q

Pulse pressure

A

Systolic pressure - diastolic pressure
Increased pulse pressure = less complaint aorta, increased stroke volume

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11
Q

Systemic vascular resistance

A

Mean arterial pressure/cardiac output

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12
Q

Bitemporal hemianopia

A

Optic chiasm lesion
More upper = inferior compression eg pituitary tumour
More lower = superior compression eg craniopharyngioma

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13
Q

Homonymous hemianopia

A

Loss of vision in same halves of both eyes
Congruous - lesion of optic radiation or occipital cortex
Incongruous - optic tract lesion
Macular spared - lesion of occipital cortex

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14
Q

Homonymous quadrantanopia (hint = PITS)

A

Homonymous = binasal/bitemporal/upper/lower, lesions are beyond optic chiasm
Superior - lesion of inferior optic radiation in temporal lobe
Inferior - lesion of superior optic radiation in parietal lobe

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15
Q

Ejection systolic murmur

A

Expiration - AS and HOCM
Inspiration - pulmonary stenosis and ASD
Tetralogy of Fallot

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16
Q

Pansystolic murmur

A

Mitral regurgitation - quieter in inspiration
Tricuspid regurgitation - louder in inspiration
VSD - harsh in character

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17
Q

Late systolic

A

Mitral valve prolapse
Coarctation of the aorta

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18
Q

Early diastolic

A

Aortic regurgitation
Pulmonary regurgitation (Graham steel murmur)

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19
Q

Mid-late diastolic

A

Mitral stenosis - rumbling
Severe aortic regurgitation - rumbling, AKA Austin flint murmur

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20
Q

Continuous machine like murmur

A

Patent ductus arteriosus

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21
Q

Loop diuretics

A

Na K Cl co-transporter in thick ascending loop of Henle
E.g. furosemide, bumetanide, torsemide

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22
Q

Thiazide like diuretics

A

Inhibition of Na/Cl co-transporter I’m distal convoluted tubule
E.g. indapamide, metolazone

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23
Q

Thiazide diuretics

A

Inhibit Na/Cl co transporter in distal convoluted tubule and collecting ducts
E.g. bendroflumethiazide

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24
Q

Aldosterone antagonists

A

Blocks effects of aldosterone on distal convoluted tubule and collecting ducts
E.g. spironolactone, eplerenone

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25
Q

Digoxin

A

Reversibly binds to Na/K/ATPase
Shortens QT
Toxicity (aggravated by low K) - dizziness, vomiting, blurred vision

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26
Q

Arrhythmia class Ia

A

Blocks sodium channels
Increases AP duration
Quinidine, procainamide, disopyramide

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27
Q

Arrhythmia class Ib

A

Blocks sodium channels
Decreases AP duration
Lidocaine, tocainide, mexiletine

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28
Q

Arrhythmia class Ic

A

Block sodium channels
Flecainide, encainide, propafenone

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29
Q

Arrhythmia class II

A

Betablockers
Propranolol, bisoprolol, atenolol

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30
Q

Arrhythmia class III

A

Blocks potassium channels
Amiodarone, sotalol,

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31
Q

Arrhythmia class IV

A

Calcium channel blockers
Verapamil, diltiazem

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32
Q

Waldenstroms macroglobinaemia

A

Lymphoplasmacytoid malignancy characterised by the secretion of a monoclonal IgM paraprotein
Seen in older men
Weight loss, lethargy, hyperviscosity, lymphadenopathy, cryoglobulinaemia
IgM paraproteinaemia
Bone marrow diagnostic
Rituximab chemo

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33
Q

Homocystinuria

A

Deficiency of cystathionine beta synthase
Autosomal recessive
Marfanoid, learning difficulties, kyphosis, seizures, DVTs
Increased serum homocysteine
Treated with B6 (pyridoxine)

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34
Q

Di George

A

Primary immunodeficiency disorder caused by T cell deficiency and dysfunction, micro deletion of chromosome 22
CATCH 22

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35
Q

Klinefelter’s

A

47 XXY
Tall, lack of secondary characteristics, small firm testes, infertile, gynaecomastia, high gonadotropin hormone and low testosterone, increased LH and FSH

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36
Q

Sulphonylureas

A

Bind to ATP dependent potassium channel on beta pancreatic cells, e.g. gliclazide

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37
Q

Clopidogrel/ticagrelor

A

Inhibits ADP binding to platelet receptors

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38
Q

Letrozole/anastrazole

A

Aromatase inhibitors that reduce peripheral oestrogen receptors

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39
Q

Churg-Strauss (eosinophilic granulomatosis with polyangiitis)

A

pANCA small-medium vessel vasculitis
Asthma, mononeuritis, eosinophilia, paranasal sinusitis

40
Q

Live vaccines

A

BCG, yellow fever, MMR, polio, typhoid

41
Q

T (8;14)

A

Burkitts lymphoma

42
Q

T (9;22)

A

CML

43
Q

T (11;14)

A

Mantle cell lymphoma

44
Q

T (11;22)

A

Ewing sarcoma

45
Q

T (15;17)

A

Acute promyelocytic syndrome

46
Q

T (14;18)

A

Follicular lymphoma

47
Q

Marfan’s

A

Autosomal dominant, FBN1 gene mutation (fibrillin-1=glycoprotein) cardiovascular, ocular, and skeletal abnormalities (tall, scoliosis, flat feet, pectus excavatum, mitral/tricuspid regurg, aortic aneurysm)

48
Q

Goodpasture’s

A

Anti-glomerular basement membrane disease, pulmonary haemorrhage and rapidly progressive glomerulonephritis, HLA DR2, renal biopsy: linear IgG deposits along the basement membrane, raised transfer factor secondary to pulmonary haemorrhages, management = plasma exchange (plasmapheresis), steroids, cyclophosphamide

49
Q

Budd Chiari syndrome

A

Thrombosis of hepatic veins, usually in context of underlying haematological disease e.g. polycythaemia rubra vera, thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies, pregnancy, combined oral contraceptive pill: accounts for around 20% of cases, classic triad of ascites, abdominal pain, and hepatomegaly. USS abdo w/ doppler

50
Q

Thyrotoxic storm

A

Precipitated by thyroid/non-thyroid surgery, trauma infection, iodine load e.g. contrast, sx include fever > 38.5ºC, tachycardia, confusion and agitation, nausea and vomiting, hypertension, heart failure, abnormal liver function test - jaundice may be seen clinically. Management = dexamethasone, luogol’s iodine, propylthiouracil/methimazole and beta blockers

51
Q

Trinucleotide rpt disorders

A

Fragile X (CGG), Huntington’s (CAG), myotonic dystrophy (CTG), Friedreich’s ataxia* (GAA), spinocerebellar ataxia, spinobulbar muscular atrophy, dentatorubral pallidoluysian atrophy

52
Q

Nerve conduction studies

A

Axonal - normal conduction velocity, reduced amplitude
Demyelinating - reduced conduction velocity, normal amplitude

53
Q

Minimal change disease

A

mainly in children, usually idiopathic, T-cell and cytokine-mediated damage to the glomerular basement membrane → polyanion loss
the resultant reduction of electrostatic charge → increased glomerular permeability to serum albumin, causes: nephrotic syndrome, normotension - hypertension is rare, highly selective proteinuria, only intermediate-sized proteins such as albumin and transferrin leak through the glomerulus
renal biopsy, normal glomeruli on light microscopy, electron microscopy shows fusion of podocytes and effacement of foot processes
Management: oral corticosteroids: majority of cases (80%) are steroid-responsive, cyclophosphamide is the next step for steroid-resistant cases

54
Q

IgG

A

Enhance phagocytosis of bacteria and viruses
Fixes complement and passes to the fetal circulation
Most abundant isotype in blood serum

55
Q

IgA

A

IgA is the predominant immunoglobulin found in breast milk. It is also found in the secretions of digestive, respiratory and urogenital tracts and systems
Provides localized protection on mucous membranes
Most commonly produced immunoglobulin in the body (but blood serum concentrations lower than IgG.)
Transported across the interior of the cell via transcytosis

56
Q

IgM

A

First immunoglobulins to be secreted in response to an infection
Fixes complement but does not pass to the fetal circulation
Anti-A, B blood antibodies (cannot pass to the fetal circulation, which could result in haemolysis)
Pentamer when secreted

57
Q

IgD

A

Role in immune system largely unknown
Involved in activation of B cells

58
Q

IgE

A

Mediates type 1 hypersensitivity reactions
Synthesised by plasma cells
Binds to Fc receptors found on the surface of mast cells and basophils
Provides immunity to parasites such as helminths
Least abundant isotype in blood serum

59
Q

Addison’s

A

Primary adrenal insufficiency, characterised by a deficiency in the hormones cortisol and aldosterone produced by the adrenal glands, hypoglycaemia, hyponatraemia, hyperkalaemia, metabolic acidosis. short synacthen test, adrenal autoantibodies

60
Q

Neuroleptic malignant syndrome

A

Associated with antipsychotics and withdrawal of L dopa. Theory is dopamine blockade induced by antipsychotics triggers massive glutamate release and subsequent neurotoxicity and muscle damage. Occurs in hours to days of starting antipsychotics. pyrexia, muscle rigidity, autonomic lability: typical features include hypertension, tachycardia and tachypnoea, agitated delirium with confusion, management = dantrolene/bromocriptine, stop antipsychotic, IVT.

61
Q

Nephrotic syndrome

A

Minimal change disease (children, Hokin’s, nsaids)
Membranous glomerulonephritis (proteinuria, nephrotic syndrome, CKD, infection, rheumatoid drugs, malignancy)
Focal segmental glomerulonephritis (idiopathic, HIV, heroin, proteinuria, nephrotic syndrome, chronic kidney disease)

62
Q

Nephritic syndrome

A

Haematuria, hypertension
Rapidly progressive glomerulonephritis - aka crescentic glomerulonephritis
rapid onset, often presenting as acute kidney injury, causes include Goodpasture’s, ANCA positive vasculitis
IgA nephropathy - aka Berger’s disease, mesangioproliferative GN
typically young adult with haematuria following an URTI, there is considerable pathological overlap with Henoch-Schonlein purpura (HSP)

63
Q

Mixed nephrotic/nephritic syndrome

A

Diffuse proliferative glomerulonephritis
classical post-streptococcal glomerulonephritis in child
presents as nephritic syndrome / acute kidney injury
most common form of renal disease in SLE
Membranoproliferative glomerulonephritis (mesangiocapillary)
type 1: cryoglobulinaemia, hepatitis C
type 2: partial lipodystrophy

64
Q

Anti-centromere

A

CREST syndrome
Aka limited scleroderma
Calcinosis, Raynaud’s, oesophageal dysfunction, sclerodactyl and telangiectasia

65
Q

Anti-histone

A

Drug-induced lupus

66
Q

Livedo reticularis

A

Livedo reticularis describes an purplish, non-blanching, reticulated rash caused by obstruction of the capillaries resulting in swollen venules.
Causes
idiopathic (most common)
polyarteritis nodosa
systemic lupus erythematosus
cryoglobulinaemia
antiphospholipid syndrome
Ehlers-Danlos Syndrome
homocystinuria

67
Q

Kallmans syndrome

A

Hypogonadotrophic hypogonadism, normal or above average height with anosmia, low testosterone, LH and FSH are low or inappropriately normal. Causes of lack of secondary sexual characteristics

68
Q

Acute Interstitial Nephritis

A

Accounts for 25% of drug induced kidney injury. Acute inflammation causing marked interstitial oedema and interstitial infiltrates in the connective tissue between renal tubules.
Triad of rash, joint pain and eosinophilia, also mild renal impairment and hypertension
sterile pyuria (wcc in urine but no infection) and white cell casts
Associated drugs: penicillin, rifampicin, NSAIDs, allopurinol, furosemide
Mx: stop causative agent, sometimes steroids

69
Q

Type 1 Renal Tubular Acidosis

A

aka distal
failure to excrete H+
Causes: hereditary (most common, diagnosed in infants and children), autoimmune (e.g. Sjogrens, SLE, thyroiditis), nephrocalcinosis (e.g. primary hyperparathyroidism, vitamin D intoxification), nephrotoxins (e.g. amphotericin B, toluene inhalation), obstructive nephropathy
hyperchloraemic acidosis, alkaline urine, and renal stone formation, normal anion gap
Mx: sodium bicarb

70
Q

Type 2 Renal Tubular Acidosis

A

aka proximal
failure to reabsorb bicarb in proximal tubule
metabolic acidosis with an inappropriately high urinary pH and hyperchloraemia (Cl- replaces HCO3 in circulation), low K, high urine HCO3-
Causes: hereditary (most common, diagnosed in infants and children), part of Fanconi syndrome (proximal tubular defects with impaired reabsorption of glucose, phosphate and amino acids as well as HCO3), vitamin D deficiency, cystinosis, lead nephropathy, amyloidosis, medullary cystic disease

71
Q

Type 3 Renal Tubular Acidosis

A

Mixed type 1 and 2
proximal bicarbonate leak in addition to a distal acidification defect (mixed proximal and distal RTA)

72
Q

Type 4 Renal Tubular Acidosis

A

Tubular hyperkalaemia

Caused by aldosterone deficiency or failure of receptors in collecting duct to respond to aldosterone causing reduced H+ and K+ excretion.
associated with renal failure caused by disorders affecting the renal interstitium and tubules
GFR >20mL/min (unlike uraemic acidosis)
always associated with hyperkalaemia (unlike others)
defect in cation-exchange in the distal tubule with reduced secretion of both H+ and K+
physiological reduction in proximal tubular ammonium excretion (impaired ammoniagenesis) due to to hypoaldosteronism, results in a decrease in urine buffering capacity
associated with: Addison’s disease or post bilateral adrenalectomy
acidosis not common unless there is associated renal damage affect the distal tubule
the H+ pump in the tubule is not abnormal so that patients with this disorder are able to decrease their urinary pH to < 5.5 in response to the acidosis
mild metabolic acidosis, HCO3 >15, hyperkalaemia

73
Q

JVP

A

A wave = atrial contraction (large if increased pressure e.g. tricuspid/pulmonary stenosis, pulmonary hypertension, absent if AF)
Cannon a waves = atrial contraction against closed tricuspid valve, seen in complete heart block, VT, nodal rhythm, single chamber pacing
C wave = closure of tricuspid valve
V wave = passive filling of blood into atrium against closed tricuspid valve, giant v waves in tricuspid regurg
X descent = fall in atrial pressure during ventricular systole
Y descent = opening of tricuspid valve

74
Q

Hypersensitivity type 1

A

Anaphylactic - IgE bound to mast cells, associated with atopy

75
Q

Hypersensitivity type 2

A

Cell bound - IgM or IgG binds to antigen on cell surface. E.g. goodpastures, pernicious anaemia, autoimmune haemolytic anaemia, haemolytic transfusion reaction, ITP, bullous pemphigoid

76
Q

Hypersensitivity type 3

A

Free antigen and antibody combine, IgG or IgA. E.g. SLE, post strep glomerulonephritis, extrinsic allergic alveolitis

77
Q

Hypersensitivity type 4

A

T cell mediated. E.g. TB, graft vs host disease, contact dermatitis, scabies, MS, GBS

78
Q

Hypersensitivity type 5

A

Antibodies recognise and bind to cell surface receptors either stimulating or blocking ligand binding. E.g. Graves, myasthenia gravis

79
Q

Anti-RNP (ribonuclear protein)

A

Mixed connective tissue disease

80
Q

Pulsus paradoxus

A

Greater than normal fall in systolic BP during inspiration = faint or absent pulse in inspiration = severe asthma/cardiac tamponade

81
Q

Slow rising/plateau pulse

A

Aortic stenosis

82
Q

Collapsing pulse

A

Aortic regurgitation, patent ductus arteriosus, hyperkinetic states e.g. anaemia, thyrotoxic, fever, exercise, pregnancy

83
Q

Pulsus alternans

A

Regular alternation of force of arterial pulse - severe LVSD

84
Q

Bisferens pulse

A

Double pulse - 2 systolic peaks, mixed aortic valve disease

85
Q

Jerky pulse

A

HOCM (also sometimes bisferiens)

86
Q

Anti-Jo

A

Polymyositis (more sensitive)
Dermatomyositis

87
Q

Anti-smooth muscle antibodies

A

Autoimmune hepatitis

88
Q

Anti Scl 70

A

Scleroderma

89
Q

Alports

A

Alport’s syndrome is usually inherited in an X-linked dominant pattern. It is due to a defect in the gene which codes for type IV collagen resulting in an abnormal glomerular-basement membrane (GBM). The disease is more severe in males with females rarely developing it.
Alport’s syndrome usually presents in childhood. The following features may be seen:
microscopic haematuria
progressive renal failure
bilateral sensorineural deafness
lenticonus: protrusion of the lens surface into the anterior chamber
retinitis pigmentosa

Diagnosis:
molecular genetic testing
renal biopsy
electron microscopy: characteristic finding is of the longitudinal splitting of the lamina densa of the glomerular basement membrane, resulting in a ‘basket-weave’ appearance

90
Q

left shift

A

lower O2 delivery
low acidity, low temp, HbF, carboxy/methaemoglobinaemia

91
Q

right shift

A

higher O2 delivery, high acidity, high temp

92
Q

Angina management

A

GTN, aspirin and statin
Add in bisoprolol or long-acting dihydropyridine CCB e.g. amlodipine/ MR nifedipine/ MR felodipine
Can be used in combination but do not give verapamil/diltiazem with beta blocker (= complete heart block/HF)
If still symptomatic, add in long acting nitrate e.g. nicorandil, , ivabradine, ISMN or ranolazine. Cannot give ivabradine with verapamil/diltiazem = bradycardia. Cannot use sildenafil etc with nitrates.

93
Q

Insecticide/organophosphate poisoning

A

Sx - inhibit anticholinesterase causing accumlation of acetylcholine, cause bradycardia, miosis, diarrhoea, confusion, vomiting, headache, weakness and increased urination. Managed with IV atropine.

94
Q

Wilson’s disease

A

Autosomal recessive disorder of copper metabolism causing accumulation. Causes hepatic, neurological and psychiatric symptoms. Caeruloplasmin is low. Hepatic, serum and urine levels of copper are high. Caused by absence of ATP7B protein.

95
Q

Minimal change disease

A

Mainly in children although accounts for 28% nephrotic syndrome in adults
Main presentation is nephrotic syndrome with normal renal function and normal histology except foot process fusion on electron microscopy
Treated with pred and cyclophosphamide for recurrent relapses. Can go on to develop FGFS.

96
Q

Minimal change disease

A

Mainly in children although accounts for 28% nephrotic syndrome in adults
Main presentation is nephrotic syndrome with normal renal function and normal histology except foot process fusion on electron microscopy
Treated with pred and cyclophosphamide for recurrent relapses. Can go on to develop FGFS.

MRCP 1 (2 decks)

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