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MRCP 2 Flashcards

1
Q

Which DMARD is most likely to cause mouth ulcers

A

Methotrexate

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2
Q

Which steroid sparing agent can be used in GCA

A

Methotrexate

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3
Q

Which porphyria syndromes present with skin sx

A

PCT
Congenital erythropoietic porphyria
Eryrthropoietic protoporphyria

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4
Q

What are two contraindications for sildenafil use in ED?

A

Unstable angina
Recent MI or stroke (prev 6mths)
Use of Nicorandil or other nitrates
Hypotension

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5
Q

What is the name of the syndrome where a close person has been replaced as an imposter

A

Capgras syndrome

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6
Q

What is the treatment for methotrexate toxicity

A

Folinic acid - bypasses DHFR step, needed to activate folic acid

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7
Q

Which drug should be given in thyroid storm

A

PTU - acts quicker than carbimazole

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8
Q

What is the first line investigation for stable angina

A

CT coronary angiography
If equivocal -> MRI perfusion study
If positive and intervention warranted -> angiography

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9
Q

Pompe disease
What is it
What are the features
What is the treatment

A

Deficiency of a-galactosidase causing glycogen deposition in organs
Risks cardiomyopathy and cardiomegaly
Treated with glucosidase

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10
Q

Drugs that are CI in idiopathic intracranial htn (7)

A 
Tetracyclines
Lithium
Contraceptives
Cimetidine
Isotretinoin
Steroids
Thyroxine
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11
Q

Sjogrens classically causes which type of renal tubular acidosis

A

Type 1

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12
Q

What is the first line treatment for restless legs syndrome

A

DA agonists - ropinerole

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13
Q

When should FFP be given in a variceal bleed

A

Fibrinogen <1

INR >1.5

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14
Q

What is the mode of action of febuxostat

A

Xanthine oxidase inhibitor, like allopurinol

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15
Q

Bilateral loin pain - what diagnosis must be considered

A

Retroperitoneal fibrosis

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16
Q

When is it safe to fly post pneumothorax

A

One week pos resolution on XR

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17
Q

Retinitis pigmentosa, chronic progressive external ophthalmoplegia, bilateral ptosis, mild cerebellar signs and a cardiac conductive defect (first degree heart block).

What is the diagnosis

A

Kearns Sayre - mitochondrial disorder

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18
Q

How are palpitations in cocaine toxicity treated

A

Verapamil

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19
Q

What is the treatment for Norwegian scabes

A

Ivermectin orally

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20
Q

haemangioblastomas can secrete what

A

Epo

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21
Q

Does acute interstitial nephritis cause proteinuria

A

Yes

Also haematuria, eosinophilia & rash

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22
Q

Which antibiotic should be avoided with aminophylline

A

Ciprofloxacin, due to inhibition of CYP 1A2 causing accumulation of aminophylline and toxicity

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23
Q

Kearns Sayre - what are the features

A

Three in the eyes
Retinitis pigmentosa
Chronic ophthalmoplegia
Bilateral ptosis

Two elsewhere
Cardiac conduction defects
Mild cerebellar signs

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24
Q

What are the two types of amyloidosis and what are the underlying causes

A

AL - driven by light chain dyscrasia / myeloma

AA - driven by inflammation - RA, and spond

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25
Q

Purkinje cell antibody
CF
Associated with

A

Peripheral neuropathy

Breast cancer

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26
Q

ASDs usually cause what on ECG

How does the axis help to distinguish

A

RBBB
LAD - more likely ostium primum (PL)
RAD - more likely ostium secondum (RS)

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27
Q

What two drugs have evidence for improvement of fibromyalgia

A

Duloxetine and pregabalin

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28
Q

What is the treatment for GI bleeding on apixaban

A

Tranexamic acid +/- prothrombin complex

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29
Q

Canakinumab
MOA
Indication

A

interleukin-1 beta receptor antagonist

Tx for acute gout in those not tolerant of NSAIDs & colchicine

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30
Q

What is the treatment for lymphatic filariasis

A

Diethylcarbamazine

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31
Q

What is the first line treatment for pouchitis

A

Abx - metronidazole or cipro

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32
Q

Which drugs potentiate / inhibit adenosine

A

Dipyridamole - potentiates effect of adenosine by blocking its cellular uptake & increasing its circulating level;
Aminophylline reduces the effect of adenosine

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33
Q

Fludarabine
MOA
SE
What drug needs to be given with it

A

MOA: Purine analogue - inhibits ribonucleotide reductase and DNA polymerase
SE: lymphopaenia -> PCP
Needs prophylactic co-trimoxazole

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34
Q

Which antibiotics can worsen myasthenia

A

Cipro & levofloxacin, gent

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35
Q

What drugs can cause an acute interstitial nephritis

A 
Abx
NSAIDs
Allopurinol
PPIs
Diuretics
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36
Q

Councilman bodies are diagnostic of what condition

How does it normally present

A

Yellow fever

Deranged LFTs and U&E, jaundice & death

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37
Q

What is the risk of vertical transmission of hep C?

What co-infection increases the probability

A

6%

HIV

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38
Q

Dukes A colorectal cancer is defined by what

What is the 5YS

A

Mucosa and submucosa involvement only

95% 5YS

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39
Q

Which antipsychotics have a high risk of inducing insulin resistance

A

Clozapine

Olazepine

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40
Q

a postero-infero-lateral STEMI is due to occlusion of what artery

A

Left circumflex

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41
Q

What 3 things can increase the risk of developing porphyria cutaena tarda

A

Hep C
Alcoholism
HIV

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42
Q

What is the best laxative for opiate use

A

Sodium docusate

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43
Q

Which anti-thyroid drugs are used when in pregnancy

A

PTU - early

Carbimazole - late

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44
Q

What is the treatment for cryptosporidium

A

Nitazoxanide

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45
Q

What are the common side effects of cisplatin

A

Hypomagnesaemia
Renal impairment
Peripheral neuropathy

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46
Q

What are the two types of hepatorenal syndrome

What are the treatments

A

Type 1 HRS
Rapid onset. Poor prognosis.
Treat with Human albumin solution & splanchnic vasconstriction (terlipressin)

Type 2
Slow gradual onset
Treat with TIPSS (tx underlying liver disease)

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47
Q

What factors are used in the staging of multiple myeloma

A

B2 microglobulin & albumin

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48
Q

What is a CI for TCAs & SSRIs

A

TCAs - IHD

SSRIs - GI bleed (plt dysfunction)

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49
Q

What mutation is seen in hairy cell leukaemia

A

B-Raf

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50
Q

What drug is used to prevent the frequency of sickle cell crises

A

Hydroxyurea

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51
Q

What should be added to the treatment for neutropenic sepsis if there has been no response after 48hrs

A

Anti-fungal

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52
Q

What must be tested before starting pregabalin

A

Renal function - dose is adjusted for renal function

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53
Q

What is the treatment of lupus nephritis?

A

Mycophenylate

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54
Q

Anti-Ri
CF
Associated with

A

Breast and small cell lung carcinoma

ocular opsoclonus-myoclonus

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55
Q

What is the treatment for Eaton-Lambert syndrome

A

3,4-diaminopyridine

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56
Q

Following a bisphosphonate treatment break, when should a DEXA scan be done

A

Within two years of the treatment break, or sooner if fragility fracture

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57
Q

What is the threshold for starting insulin in gestational DM

A

Fasting glucose >7, or >6 with sx

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58
Q

What is the chromosomal translocation in Burkitt’s lymphoma

A

t(8;14)

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59
Q

Tinnitus is a SE of what antibiotic

A

Vancomycin

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60
Q

What is the test to distinguish between type 1 & 2 amiodarone-induced thyrotoxicosis

A

Colour flow doppler ultrasonography

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61
Q

What infection can cause fever and a small joint polyarthritis

A

Brucellosis

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62
Q

What are the causes of acute interstitial nephritis

A

Drugs - penicillin, cephalosporins, rifampicin, ciprofloxacin, allopurinol, frusemide, NSAIDs
Infection - CMV, legionella, strep
Sarcoidosis
Idiopathic

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63
Q

What is the treatment for latent TB

A

3mths rifampicin & isoniazid
OR
6mths isoniazid alone

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64
Q

What is the safest anticonvulsant in pregnancy

A

lamotrignine

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65
Q

What drug is contraindicated in atrial flutter

A

Flecainide - risk of converting 2:1 conduction into 1:1, unless a beta blocker or CCB is given first

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66
Q

What is the gold standard test for small bowel bacterial overgrowth

A

Jejunal aspirate

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67
Q

When is PCI indicated in stable angina

A

stable coronary artery disease and ischaemia in > 10 % of the left ventricle.

68
Q

What 2 things are not reversible & reversible in haemochromatosis

A

Irreversible - Cirrhosis & hypogonadism

Reversible - transaminitis & fatigue

69
Q

What sort of autoimmune haemolytic anaemia does lymphoma cause

70
Q

What is the treatment for chronic Hep B, eAg -ve, with no liver decompensation

A

IFN-a alone

If decompensation -> entecavir / tenofovir

71
Q

What features distinguish a common peroneal nerve palsy from an L5 radiculopathy

A

Inversion of the foot is spared in a common peroneal nerve palsy, but is weak in L5 radiculopathy

Sensory loss is usually around the lateral aspect of the lower leg and the dorsum of the foot while L5 appears as a thin strip down the middle of the anterior lower limb, usually not affect the lateral lower leg

72
Q

How does Wellens syndrome present and what does it signify?

A

TWI in V2-3, indicating critical LAD stenosis.

Need for urgent PCI. Tx as STEMI

73
Q

What must be considered in a renal transplant pt presenting with diarrhoea

A

Cryptosporidium

74
Q

What are the thresholds for carotid endarterectomy

A

TIA or stroke with significant CAS (M >50%; F >70%) corresponding to the same side as the stroke/TIA -> urgent CEA within 14 days.

NICE guideline - intervene if corresponding side has stenosis >70%

75
Q

SE of mycophenylate

A

Blood (2)
Pancytopaenia
Pure red cell aplasia

Mouth (2)
Taste disturbance
Gingival hyperplasia

GI (3)
Nausea and vomiting
Constipation
Gastrointestinal ulceration and bleeding.

76
Q

When is cyproheptadine used

A

Serotonin syndrome eg MDMA OD

77
Q

What is the treatment of granulomatosis with polyangiitis

A

Steroids with cyclophosphamide/ritux

78
Q

What are the criteria for AKI staging

A

Stage 1 - rise in creatinine >26 or increase in baseline up to x2. Less than 0.5ml/kg/hr urine output for 6-12hrs

Stage 2 - up to x3 rise in creatinine from baseline, or <0.5ml/kg/hr urine output for >12hrs

Stage 3 - >x3 increase in baseline creatinine or >350 increase in creatinine or imitation of RRT

79
Q

What are the first and second line medical treatments for HOCM

A

b-blocker or CCB
Then dispyramide
Then DDR pacemaker or myectomy

80
Q

What are the criteria for frequency of colonoscopy in UC/Crohns?

A

Lower risk - 5 yearly colonoscopy
Extensive colitis with no active endoscopic/histological inflammation
OR left sided colitis
OR Crohn’s colitis of <50% colon

Intermediate risk - 3 yearly colonoscopy
Extensive colitis with mild active endoscopy/histological inflammation
OR post-inflammatory polyps
OR family history of colorectal cancer in a first degree relative aged 50 or over

Higher risk - 1 yearly colonoscopy
Extensive colitis with moderate/severe active endoscopic/histological inflammation
OR stricture in past 5 years
OR dysplasia in past 5 years declining surgery
OR primary sclerosing cholangitis / transplant for primary sclerosing cholangitis
OR family history of colorectal cancer in first degree relatives aged <50 years

81
Q

What is the treatment regime for stage III follicular lymphoma

82
Q

Which drug can worsen bullies pemphigoid?

A

Furosemide

83
Q

What are the indications for valve replacement in mitral stenosis

A

Area <1cm2

84
Q

Which drug class should be stopped when giving ciclosporin

85
Q

How long must someone not drive after a seizure

A

6mths if normal EEG and no underlying cause found

Otherwise 1yr

86
Q

What is the treatment for necrobiosis lipoidica

A

Topical steroids

Occurs in DM

87
Q

what is the side effect of carbimazole apart from agranulocytosis

A

Deranged LFTs & jaundice - hepatotoxicity

88
Q

What is the tx for IgA GN

A

BP control with ACEi;
Acute
If acute inflammation seen on biopsy, or persistent haematuria -> High dose prednisolone.
If rapid deterioration in renal function -> prednisolone + cyclophosphamide or azathioprine
Chronic
Immunosuppression and steroids if CKD

89
Q

Does pregnancy increase or decrease the risk of a flare of SLE?

90
Q

Nitazoxanide is a treatment for what

A

Cryptosporidium

91
Q

What is the first line treatment for Wilsons

92
Q

How is poyarteritis nodosa treated

93
Q

What is the triad of Felty’s syndrome

A

Neutropaenia & splenomegaly in RA

94
Q

What must be done before starting clozapine (2)?

A

ECG

Baseline WCC

95
Q

Anti-GAD antibody
CF
Associated with

A

Breast, colorectal and small cell lung carcinoma

stiff person’s syndrome or diffuse hypertonia

96
Q

What are the truelove Witts criteria

What are the criteria for severity

A

2 bowels, 2 obs, 2 bloods

Bowels - number open per day; blood
Obs - temp (>37.8); HR (>90)
Bloods - ESR (>30); Hb (<105)

Mild
<4 stools a day; Small amount of blood

Moderate
4-6 stools a day; Varying amount of blood
No systemic upset

Severe
>6 stools a day
Systemic features - fever, tachycardia
Anaemia and raised ESR

97
Q

Inverted p wave in lead I, RAD and poor R wave progression suggests what

A

dextrocardia

98
Q 
What is the first line drug class for OCD
Which has less of a positive impact
A

SSRIs
Not citalopram / escitalopram

Can use TCAs, but clomipramine only

99
Q

What is the best test for prediction of severity of COPD

A

FEV1 % of predicted

100
Q

What is the follow up on gestational DM?

A

Fasting blood sugar at 3mths post partum, with annual fasting sugars subsequently

101
Q

What fungal blood test is positive in PCP

A

1,3-b-D-glucan

102
Q

What are the features of severe malaria

A

Falciparum
Schizonts on blood film
Parasitaemia >2%

-> tx with IV ACT

103
Q

Which vasculitis is most associated with testicular pain

A

polyarteritis nodosa

104
Q

When are paracetamol levels taken and NAc started post OD

105
Q

When should a statin be started post ischaemic stroke

A

48hrs - 80mg atorvastatin

106
Q

Which antiretroviral drug is avoided in pts positive for B5701 allele

A

Abacavir - increased risk of fatal hypersensitivity reaction

107
Q

What is Gaucher’s disease

What are the CF

A

AR deficiency of glucocerbrocidase causing accumulation -> hepatosplenomegaly & pancytopaenia

108
Q

What is the first line treatment for macroprolactinomas

A

Medical - Dopamine agonists

109
Q

What antimicrobial is used to treat cryptosporidium

A

paromomycin

110
Q

What is the treatment for lead poisoning

A

EDTA acutely

DMSA chronically

111
Q

When should mast cell tryptase be taken to confirm anaphylaxis

A

Immediately and within 1-2hrs

112
Q

Which class of lupus nephritis carries the worst prognosis?

A

Diffuse proliferative - class IV

113
Q

If numb rash, what is the diagnosis

114
Q

What is the dose of statin that should be started in t1dm?

What are the criteria for starting

A 
20mg atorvastatin 
>10yrs since diagnosis
>40yrs
CVD disease
Nephropathy
115
Q

What is the main SE of ketamine

A

Raised ICP

116
Q

Which porphyria syndromes present with neurovisceral symptoms

A

AIP

Aminolaevulinic acid dehydrogenase porphyria (Lead poisoning)

117
Q

Amiodarone induced thyrotoxicosis
What are the features of the two types
How are they treated

A

Type 1 - increased hormone synthesis
Goitre

Type 2 - destructive
No goitre
Steroids

If goitre -> carbimazole and/or potassium percolate
If no goitre -> steroids

118
Q

what is the target for t2dm management

A

If drug not associated with hypoglycaemia - HbA1c 6.5-7.5%

If associated with hypoglycaemia - HbA1c 7.0%

119
Q

Renal tubular acidosis type 1
Defect
Sx

A

Inability to reabsorb HCO3 from the proximal tubule
Much less likely to form stone
Hypo-K & normal anion gap metabolic acidosis

120
Q

Eosinophilia with diarrhoea and rash prompts what infection?

What is the treatment

A

Strongyloides

Ivermectin

121
Q

Htn, hypo-K, low renin and low aldosterone point to which diagnosis

A

Liddle’s syndrome - give amiloride, not spiro

122
Q

What is the treatment of scalp psoriasis

A

Scalp psoriasis - first-line treatment is topical potent corticosteroids

123
Q

Anti-Hu
CF
Associated with

A

Small cell lung carcinoma and neuroblastomas

sensory neuropathy - may be painful
cerebellar syndrome
encephalomyelitis

124
Q

First line systemic tx in psoriasis

A

Methotrexate

125
Q

Which combination of lobar emphysema and exercise tolerance is a contraindication to lung volume reduction surgery

A

High exercise tolerance

Lower/middle lobe disease

126
Q

What drug can precipitate a scleroderma renal crisis

A

Prednisolone

127
Q

Which antiretroviral increases the risk of renal stones

128
Q

What sort of renal stones does IBD predispose to

129
Q

What is the target blood pressure in CKD

130
Q

Commonest causes of nephrotic syndrome

A

MMF
Membranous GN
Minimal change disease
FSGS

131
Q

If eosinophils and lung sx, what is the diagnosis

A

Pulmonary eosinophilia - think worms & flukes

132
Q

What are the three classic sx of Whipples disease

A

Seronegative arthropathy
Weight loss
Diarrhoea

133
Q

What is a contraindication for interferon use in MS

A

Deranged LFTs

134
Q

What is the treatment for latent TB

A

3mths of rifampicin & isoniazid OR 6mths of isoniazid

135
Q

SE of mycophenylate

A 
Pancytopaenia 
Taste disturbance
Gingival hyperplasia
Nausea and vomiting
Constipation
Gastrointestinal ulceration and bleeding.
136
Q

What is given as prophylaxis for hypokalaemia periodic paralysis

A

Acetazolamide

137
Q

What treatment is used to prevent cysteine ureteric stones

A

D-penicillamine

138
Q

Which porphyria syndromes present with neurovisceral and skin sx

A

Hereditary coproporphyria

Variegate porphyria

139
Q

Warfarin induced skin necrosis is associated with what

A

Protein C deficiency - same as Calciphylaxis

140
Q

What are the key distinguishing features between Gitelman & Bartter’s syndromes

A

Bartter’s - hypokalaemia with hypercalciuria (stones); more likely to present in children and be more severe

Gitelman - hypokalaemia with hypocalciuria; more likely to present in adults; milder

141
Q

anti-emetic which blocks acetylcholine, dopamine, and serotonin receptors

A

Levomepromazine is a ‘dirty drug’ which blocks lots of different receptors (e.g. ACh, DA, 5HT). It is therefore a broad spectrum anti-emetic. It is first line in the last days of life.

142
Q

What is the first line anticholinergic in overactive bladder syndrome

A

Solifenacin

143
Q

Pancoasts tumours tend to be of what type

144
Q

What is the treatment for chronic methaemoglobinaemia

A 
Ascorbic acid (vit C)
IV methylene blue acutely
145
Q

What must you consider with vague GI sx and low B12 / vit ADEK?
What is the test

A

Small bowel bacterial overgrowth

Hydrogen breath test

146
Q

What is a drug cause of microscopic colitis

147
Q

What is the treatment for methotrexate induced lung fibrosis

148
Q

What is the treatment for membranous GN

A

1st line - BP control with ACEi

2nd line, if refractory - steroids and cyclophosphamide

149
Q

Which drug should be stopped when giving clopidogrel

A

Omeprazole - switch to lansoprazole as it doesn’t inhibit metabolism of clopidogrel to its active metabolite

150
Q

Renal tubular acidosis type 1
Defect
Sx

A

Inability to secrete H+ in the distal tubule

Stones, hypo-K & normal anion gap metabolic acidosis

151
Q

How is diabetic gastroparesis best managed

A

erythromycin acutely

domperidone long term

152
Q

What kind of stones are predisposed to post ileostomy

153
Q

Which renal disease is hep B most associated with

A

Membranous GN

154
Q

What is the target BP in diabetes

A

If no end organ damage, <140/80

If end organ damage, <130/80

155
Q

Which DMARD is best used in pregnancy for RA

A

Azathioprine

156
Q

Which drug is used to precipitate ECG changes in Brugada syndrome
What are those changes

A

Flecainide

Downward sloping ST segments in V1-V3

157
Q

What are the features of VHL syndrome

A

Cerebellar haemangiomas - can cause SAH
Renal cysts (can be pre-malignant)
Extra renal cysts - epididymal, pancreatic, hepatic
Phaeochromocytoma
Clear cell renal carcinoma
endolymphatic sac tumours
retinal haemangiomas: vitreous haemorrhage

158
Q

hereditary spherocytosis - intravascular or extravascular haemolysis

A

extravascular - gallstones, jaundice and splenomegaly

159
Q

What is the second line agent for familial hypercholesterolaemia after high dose atorvastatin

160
Q

What schistosomiasis causes bladder inflammation

A

Haematobium

161
Q

Anti-Yo
CF
Associated with

A

Ovarian and breast cancer

cerebellar syndrome

162
Q

What is the treatment for cryptosporidiosis

163
Q

What conditions are included in polyglandular autoimmune syndromes type 1 & 2

A 
Type 1 - Addisions, mucocutaneous candidiasis &amp; hypo-PTHism
Type 2 (Schmidt's) - Addison's +/- T1DM &amp; thyroid disease
164
Q

PTHrP associated hyper-Ca is associated with which lung cancer

A

Squamous cell

165
Q

What is the treatment for GBM?

A

Surgery followed by chemo-radiotherapy with temozolomide

166
Q

What is the only absolute contraindication to electroconvulsive therapy

A

Raised intracranial pressure

167
Q

What is the treatment of multi drug resistant TB

A

5 drugs; 18-24mths

MRCP (3 decks)

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