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MRCP Flashcards

1
Q

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

A

Acute cerebellar haemorrhage

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2
Q

Painless lymphadenopathy, Splenomegaly, Anaemia, Thrombocytopenia, Neutropenia

A

Chronic myeloid leukaemia

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3
Q

IgA vasculitis - aka? Tetrad? Risk factors?

A

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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4
Q

Renal biospy shows mesangial IgA deposition - Dx?

A

IgA Vasculitis (Henoch Schonlein purpura)

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5
Q

See image

A

See image

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6
Q

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

A

Anti-cardiolipin antibodies

Antiphospholipid syndrome

–> Renal vein thrombosis

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7
Q

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?

A

Supraventricular tachycardia

Most likely to explain patient’s symptoms

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8
Q

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

Recent visit to India

Stool culture -ve

Anti-TTG Ab -ve

A

Giardisis

Stool cultures are often falsely negative in Giardiasis

Viral gastroentertitis is unlikely to be so chronic

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9
Q

20 year old T2DM. Dx? Genetic mutation?

A

MODY

HNF-1a mutation

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10
Q

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

A

Cardiogenic syncope (e.g. VT)

ECG shows ventricular aneurysm

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11
Q

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

A

Holmes-Adie pupil

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12
Q

Renal stone. High urinary calcium. Prevention?

A

Potassium citrate

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13
Q

Hx of excessive bleeding after dental procedure. Dx?

A

Von WIllebrand’s disease

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14
Q

Most common phenotype for a1 anti-trypsin deficiency?

A

PiZZ

Homozygous

Autosomal recessive

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15
Q

What are the secondary causes of hypercholesterolaemia?

A

Hypothyroidism

Nephrotic syndrome

Cholestasis

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16
Q

What are the secondary causes of hypertriglyceridaemia?

A

T1DM/T2DM

Obesity

Chronic renal failure

Liver disease

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17
Q

New asymmetrical thyroid swelling + cervical lymphadenopathy. Dx?

A

Thyroid cancer

(most likely Papillary thyroid cancer as most common type)

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18
Q

Burkitt lymphoma. What gene?

A

c-Myc is associated with Burkitt’s lymphoma

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19
Q

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

A

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

Encapsulated bacteria (NHS)

  • Neisseria meningitides
  • Haemophilus influenzae
  • Streptococcus pneumoniae
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20
Q

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

A

Hodgkin’s lymphoma

Reed-Sternberg cell

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21
Q

NSAIDs cause AKI? What type?

A

Acute interstitial nephritis (AIN)

Renal AKI

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22
Q

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

A

Insulinoma

Supervised prolonged (72 hours) fasting serum glucose

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23
Q

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

A

Bile salt induced dirarrhoea

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24
Q

Suspected septic arthritis. Ix?

A

Blood culture!

Then urgent joint aspiration

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25
Q

Common peroneal nerve injury vs L5 radiculopathy

A

Common peroneal nerve injury

  • Loss of ankle eversion
  • Normal ankle inversion
  • Loss of sensation over anterolateral leg and dorsum of foot

L5 radiculopathy

  • Weakness of ankle dorsiflexion + ankle inversion
  • Weakness of hip abduction
  • Loss of sensation in 1st webspace of foot
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26
Q

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

A
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27
Q

Valsalva manoeuvre - 1st haemodynamic response

A

↓ venous return

–> reduced predload

–> reduced cardiac output

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28
Q

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

A

Amlodipine (since on Lithium)

Usually < 55 year olds would start ACEi/ARB

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29
Q

Amitryptylline overdose. What class of drug? Tx?

A

TCA overdose

IV sodium bicarbonate

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30
Q

Hyperacute rejection? Which Ig?

A

IgG (pre-existing humoral immunity)

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31
Q

Triad of Ophthalmopegia, Ataxia, Areflexia. Dx?

A

Miller-Fisher syndrome

Variant of GBS

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32
Q

Sudden onset, unilateral, painless loss of vision

Pale retina

Cherry red spot

Dx? Cause?

A

Central retinal arterial occlusion

Embolism or Giant cell arteritis

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33
Q

Haemodialysis. Infection from line. Most common cause?

A

Staphylococcus epidermidis

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34
Q

Class and Complications of Ciprofloxacin

A

Quinolones (e.g. Ciprofloxacin)

S/E: Tendinopathy

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35
Q

Most common cause of traveller’s diarrhoea

A

E. coli

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36
Q

Ix for occupational asthma

A

Serial PEFR measurements (at work + away from work)

37
Q

Ix to confirm goitre causing breathlessness

A

Spirometry

38
Q

Lung cancer - Ix to assess suitability for surgical resection?

39
Q

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

A

Coronary artery dissection

40
Q

Primary biliary cirrhosis

Ix to confirm diagnosis?

A

Anti-mitochondrial antibodies

41
Q

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

A

Fibrillin-1 gene

42
Q

Erythrodermic psoriasis - 1st Tx?

A

Topical white soft paraffin

43
Q

Lipodermatosclerosis causes pigmentation in which layer of skin

A

Hypodermis

44
Q

Dominant parietal lobe lesion causes

A

Gerstmann syndrome

  • Finger agnosia
  • Acalculia
  • Agraphia
  • Left-right limb disorientation
45
Q

Thiazide diuretics MOA, S/E

A

Inhibit NaCl cotransporter in DCT

S/E: Hypokalaemia

Increase Na excretion (but kidney swaps Na for K to save Na)

46
Q

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

A

Myasthenia gravis

Thymoma causing paraneoplastic M. gravis

47
Q

Bloody diarrhoea. Fever. Abdo tender. First Ix?

48
Q

Clopidogrel MOA

A

P2Y12 class ADP receptor antagonist

49
Q

Systemic sclerosis with chronic diarrhoea - what complication?

A

Bacterial overgrowth

(due to reduced peristalsis)

50
Q

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

A

Urate lowering thearpy (allopurinol) may trigger acute gout

51
Q

What do the following get broken down into:

Lactulose

Maltose

Sucrose

A

Lactose = Glucose + Galactose

Maltose = Glucose disaccharide

Sucrose = Glucose + Fructose

52
Q

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

A

Giardiasis

53
Q

WCC 35. Splenomegaly, Lymphadenopathy Anaemia - Dx?

A

Chronic lymphocytic leukaemia (CLL)

or Chronic myeloid leukaemia (CML)

54
Q

H. pylori is associated with which peptic ulcer disease

A

H. pylori are assocaited with Duodenal ulcers

55
Q

Pulsus paradoxus - definition? associated with?

A

Pulsus paradoxus = abnormal decrease in sBP and pulse wave with inspiration

Associated with constrictive pericarditis / cardiac tamponade

56
Q

Young person + Nephrotic syndrome

A

Minimal change disease

57
Q

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

58
Q

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

A

Polymyositis

59
Q

3-mm ST-segment depression in leads V1 to V3, with upright T waves and tall R waves

Diagnosis? Which coronary artery?

A

Posterior MI

Supplied by posterior interventricular artery (PIVA)

  • Branch of Right coronary artery (90%)
  • Branch of Left circumflex artery (10%)
60
Q

Diarrhoea, Low platelet, AKI, Confusion - Dx?

Classical Tetrad? Pentad?

A

HUS

  • MAHA
  • Thrombocytopenia
  • AKI

TTP

  • + Fever
  • + Neurological symptoms

Caused by E coli O157:H7

61
Q

BNP is released by

A

Ventricles

62
Q

ANP released by

63
Q

Cisplatin S/E

A

Sensory neuropathy (hearing loss)

64
Q

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

A

Aspirin –> worsens Asthma + causes nasal polyps

65
Q

C/I to donating blood

A

Previous blood transfusion

To reduce risk of vCJD

66
Q

diffuse pain in the right arm

numbness in the right thumb

reduced biceps reflex

Dx?

A

C6 radiculopathy

67
Q

diffuse swelling of her right index DIPJ and her left fourth toe.

(i.e. DIPJ + Dactylitis)

Dx?

A

Psoriatic arthritis

Mono/Poly arthritis affecting DIP

68
Q

Retinal haemorrhages - Dx?

A

Retinal vein occlusion

69
Q

What cellular component contains double-stranded circular DNA?

A

Mitochondria

Read the question!

70
Q

Mesenteric adenitis - cause?

A

Yersinia enterocolitica

72
Q

Discoid lupus - Tx (1st, 2nd)

A

(1) Topical corticosteroids
(2) Hydroxychloroquine

73
Q

Leucoerythroblastic film

  • definition, what does it indicate?
A

Presence of immature red (reticulocytes) and white (blast) cells

Bone marrow infiltration (e.g. metastases, myelofibrosis)

75
Q

Alteplase MOA

A

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

76
Q

mycophenolate mofetil, tacrolimus, prednisolone, co-trimoxazole and valganciclovir.

Which one causes a tremor?

A

Tacrolimus

77
Q

What factors increase and decrease pulmonary vascular resistance

A

Increased PVR

  • Hypoxia
  • Noradrenaline (norepinephrine)
  • Endothelin

Decreased PVR

  • Epoprostenol (prostacyclin).

N.B. Effects of hypocapnia are variable

79
Q

Gradual onset

LMN features

Loss of pain and temperature in upper limbs

Normal light touch

Dx?

A

Syringomyelia

80
Q

Mechanism of Aciclovir S/E causing AKI

A

Forms crystals in tubules

81
Q

Cavernous sinus contents

A
  • CN3
  • CN4
  • CN V1
  • CN V2
  • CN 6
  • Internal carotid artery + sympathetic plexus
82
Q

Causes of erythema nodosum

A
  • IBD
  • Sarcoidosis
  • TB (or other infection)
  • Malignancy (Lymphoma)
83
Q

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

A

Excision biopsy of cervical lymph node

Likely Hodgkin’s lymphoma

84
Q

Origin of foam cells

85
Q

Antibiotic prophylaxis for close contacts of bacterial meningitis

Which ABx?

A

Ciprofloxacin

86
Q

Fever, Arthritis, Salmon-pink rash, HIGH Ferritin

Usually children but can occur in adults

Diagnosis?

A

Adult onset Still’s disease

RW FY1 (15 decks)

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