MRCP Flashcards by Richard Wu

65-year-old woman presented with a 12-hour history of sudden-onset gait unsteadiness, vomiting and headache, followed by increasing drowsiness. Diagnosis?

Acute cerebellar haemorrhage

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Painless lymphadenopathy, Splenomegaly, Anaemia, Thrombocytopenia, Neutropenia

Chronic myeloid leukaemia

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IgA vasculitis - aka? Tetrad? Risk factors?

Henoch-Schonlein purpura

Palpable, non-blanching, purpuric rash on buttocks and extensor surfaces

Arthralgia

Abdominal pain

Glomerulonephritis

Peri-articular oedema

Usually affects Children

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Renal biospy shows mesangial IgA deposition - Dx?

IgA Vasculitis (Henoch Schonlein purpura)

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See image

See image

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45 year old, right flank pain, livedo reticularis, past obstetric complications, haematuria + proteinuria, anaemia, thrombocytopenia - Ix?

Anti-cardiolipin antibodies

Antiphospholipid syndrome

–> Renal vein thrombosis

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Lightheadedness. 24hr ECG shows

atrial and ventricular premature beats; nocturnal bradycardia and Mobitz type I atrioventricular block, and supraventricular tachycardia

Which is clinically most important?

Supraventricular tachycardia

Most likely to explain patient’s symptoms

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1 month Hx of weight loss, abdo distention, flatulence, foul smelling diarrhoea

Recent visit to India

Stool culture -ve

Anti-TTG Ab -ve

Giardisis

Stool cultures are often falsely negative in Giardiasis

Viral gastroentertitis is unlikely to be so chronic

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20 year old T2DM. Dx? Genetic mutation?

MODY

HNF-1a mutation

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72M, multiple episodes of collapse lasting 1min, PMHx MI (4 years ago), now asymptomatic, ECG: SR, anterior Q waves + anterior ST elevation? Diagnosis?

Cardiogenic syncope (e.g. VT)

ECG shows ventricular aneurysm

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Unilateral dilated pupil, very slowly reactive to light, absent knee/ankle jerk. Dx?

Holmes-Adie pupil

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Renal stone. High urinary calcium. Prevention?

Potassium citrate

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Hx of excessive bleeding after dental procedure. Dx?

Von WIllebrand’s disease

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Most common phenotype for a1 anti-trypsin deficiency?

PiZZ

Homozygous

Autosomal recessive

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What are the secondary causes of hypercholesterolaemia?

Hypothyroidism

Nephrotic syndrome

Cholestasis

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What are the secondary causes of hypertriglyceridaemia?

T1DM/T2DM

Obesity

Chronic renal failure

Liver disease

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New asymmetrical thyroid swelling + cervical lymphadenopathy. Dx?

Thyroid cancer

(most likely Papillary thyroid cancer as most common type)

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Burkitt lymphoma. What gene?

c-Myc is associated with Burkitt’s lymphoma

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Splecnectomy planned. What should you to vaccinate against and when?

At least 2 weeks before surgery (e.g. 1 month before)

Encapsulated bacteria (NHS)

Neisseria meningitides
Haemophilus influenzae
Streptococcus pneumoniae

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17 F, single, painless, enlarged cervical lymph node. CXR mediastinal lymphadenopathy. Dx? Characteristic cell type?

Hodgkin’s lymphoma

Reed-Sternberg cell

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NSAIDs cause AKI? What type?

Acute interstitial nephritis (AIN)

Renal AKI

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Episodic sweating and hunger. Weight gain. Dx? Ix?

Insulinoma

Supervised prolonged (72 hours) fasting serum glucose

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Crohn’s disease had terminal ileal resection. Now diarrhoea. Dx?

Bile salt induced dirarrhoea

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Suspected septic arthritis. Ix?

Blood culture!

Then urgent joint aspiration

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**Common peroneal nerve injury** vs **L5 radiculopathy**

**Common p**_e_**ron**_e_**al nerve injury** * Loss of ankle **_e_**version * Normal ankle inversion * Loss of sensation over anterolateral leg and dorsum of foot **L5 rad**_i_**culopathy** * Weakness of ankle dorsiflexion + ankle **_i_**nversion * Weakness of hip abduction * Loss of sensation in 1st webspace of foot

Post-partum, Headache, Drowsiness, Focal neurological signs, Seizures - Dx?

Valsalva manoeuvre - 1st haemodynamic response

**↓ venous return** --\> reduced predload --\> reduced cardiac output

30 year old Bipolar on Lithium has high BP. 1st drug?

**Amlodipine** (since on Lithium) Usually \< 55 year olds would start ACEi/ARB

Amitryptylline overdose. What class of drug? Tx?

TCA overdose ## Footnote **IV sodium bicarbonate**

Hyperacute rejection? Which Ig?

IgG (pre-existing humoral immunity)

Triad of Ophthalmopegia, Ataxia, Areflexia. Dx?

**Miller-Fisher syndrome** Variant of GBS

Sudden onset, unilateral, painless loss of vision Pale retina Cherry red spot Dx? Cause?

**Central retinal arterial occlusion** **Embolism** or **Giant cell arteritis**

Haemodialysis. Infection from line. Most common cause?

**Staphylococcus epidermidis**

Class and Complications of Ciprofloxacin

**Quinolones** (e.g. Ciprofloxacin) S/E: **Tendinopathy**

Most common cause of traveller's diarrhoea

E. coli

Ix for occupational asthma

Serial PEFR measurements (at work + away from work)

Ix to confirm goitre causing breathlessness

Spirometry

Lung cancer - Ix to assess suitability for surgical resection?

PET scan

20F post partum with no cardiovascular risk factors has STEMI. Cause?

Coronary artery dissection

**Primary biliary cirrhosis** Ix to confirm diagnosis?

**Anti-mitochondrial antibodies**

Marfan's syndrome is caused by mutation in which gene?

Fibrillin-1 gene

Erythrodermic psoriasis - 1st Tx?

Topical white soft paraffin

Lipodermatosclerosis causes pigmentation in which layer of skin

Hypodermis

Dominant parietal lobe lesion causes

Gerstmann syndrome * Finger agnosia * Acalculia * Agraphia * Left-right limb disorientation

Thiazide diuretics MOA, S/E

**Inhibit NaCl cotransporter in DCT** S/E: Hypokalaemia Increase Na excretion (but kidney swaps Na for K to save Na)

Double vision, Ptosis, Truncal muscle weakness, CXR widened mediastinum - Dx?

**Myasthenia gravis** Thymoma causing paraneoplastic M. gravis

Bloody diarrhoea. Fever. Abdo tender. First Ix?

**AXR**

Clopidogrel MOA

**P2Y12 class ADP receptor antagonist**

Systemic sclerosis with chronic diarrhoea - what complication?

Bacterial overgrowth | (due to reduced peristalsis)

Recently started allopurinol for gout 2 weeks ago. Now multiple painful joints. Dx?

Urate lowering thearpy (allopurinol) may trigger acute gout

What do the following get broken down into: Lactulose Maltose Sucrose

Lactose = Glucose + Galactose Maltose = Glucose disaccharide Sucrose = Glucose + Fructose

Recent travel to Indian, fowl smelling diarrhoea, flatulence, abdo distention, weight loss - Dx

Giardiasis

WCC 35. Splenomegaly, Lymphadenopathy Anaemia - Dx?

Chronic lymphocytic leukaemia (**CLL**) or Chronic myeloid leukaemia (**CML**)

H. pylori is associated with which peptic ulcer disease

H. pylori are assocaited with **Duodenal ulcers**

Pulsus paradoxus - definition? associated with?

**Pulsus paradoxus** = abnormal decrease in sBP and pulse wave with inspiration Associated with **constrictive pericarditis / cardiac tamponade**

Young person + Nephrotic syndrome

**Minimal change disease**

Bloody diarrhoea, weight loss, pruritis, jaundice, raised ALP

UC + PSC

progressive (proximal) muscle weakness, raised CK 3000, raised ESR - Dx

**Polymyositis**

3-mm ST-segment depression in leads V1 to V3, with upright T waves and tall R waves Diagnosis? Which coronary artery?

**Posterior MI** Supplied by posterior interventricular artery (**PIVA**) * Branch of **Right coronary artery** (90%) * Branch of **Left circumflex artery** (10%)

**Diarrhoea, Low platelet, AKI, Confusion** - Dx? Classical Tetrad? Pentad?

**HUS** * **MAHA** * **Thrombocytopenia** * **AKI** **TTP** * **+ Fever** * **+ Neurological symptoms** Caused by E coli O157:H7

BNP is released by

Ventricles

ANP released by

Atria

Cisplatin S/E

Sensory neuropathy (hearing loss)

Asthma + blocked nose started on new drug recently - what drug?

Aspirin --\> worsens Asthma + causes nasal polyps

C/I to donating blood

**Previous blood transfusion** To reduce risk of vCJD

**diffuse pain in the right arm** **numbness in the right thumb** **reduced biceps reflex** Dx?

C6 radiculopathy

diffuse swelling of her right index DIPJ and her left fourth toe. (i.e. **DIPJ + Dactylitis**) Dx?

**Psoriatic arthritis** Mono/Poly arthritis affecting DIP

Retinal haemorrhages - Dx?

**Retinal _vein_ occlusion**

What cellular component contains double-stranded circular DNA?

**Mitochondria** Read the question!

Mesenteric adenitis - cause?

Yersinia enterocolitica

Discoid lupus - Tx (1st, 2nd)

(1) Topical corticosteroids (2) Hydroxychloroquine

Leucoerythroblastic film - definition, what does it indicate?

Presence of immature red (reticulocytes) and white (blast) cells Bone marrow infiltration (e.g. metastases, myelofibrosis)

Alteplase MOA

It cleaves plasminogen --\> plasmin which degrades the fibrin matrix of the thrombus.

mycophenolate mofetil, tacrolimus, prednisolone, co-trimoxazole and valganciclovir. Which one causes a tremor?

Tacrolimus

What factors increase and decrease pulmonary vascular resistance

Increased PVR * Hypoxia * Noradrenaline (norepinephrine) * Endothelin Decreased PVR * Epoprostenol (prostacyclin). N.B. Effects of hypocapnia are variable

Gradual onset LMN features Loss of pain and temperature in upper limbs Normal light touch Dx?

Syringomyelia

Mechanism of Aciclovir S/E causing AKI

Forms crystals in tubules

Cavernous sinus contents

* CN3 * CN4 * CN V1 * CN V2 * CN 6 * Internal carotid artery + sympathetic plexus

Causes of erythema nodosum

* **IBD** * **Sarcoidosis** * **TB** (or other **infection**) * Malignancy (**Lymphoma**)

16 boy with 9 month history of painless, neck swelling with cervical lymphadenopathy. Normal CXR. Next step Ix?

**Excision biopsy of cervical lymph node** Likely **Hodgkin's lymphoma**

Origin of foam cells

Monocytes

Antibiotic prophylaxis for close contacts of bacterial meningitis Which ABx?

**Ciprofloxacin**

**Fever, Arthritis, Salmon-pink rash, HIGH Ferritin** Usually children but can occur in adults Diagnosis?

**Adult onset Still's disease**