MRCP 2

Question 1

Lateral medullary syndrome findings

Answer 1

Ipsilateral facial pain + temperature loss

Contralateral limb pain and temperature loss

Ataxia + nystagmus

Question 2

Lateral medullar syndrome - stroke location

Answer 2

Posterior inferior cerebellar artery

Question 3

Myotonic dystrophy features

Answer 3

• myotonic facies
• frontal balding
• bilateral ptosis
• cataracts
• dysarthria

Question 4

CHADSVASC scoring

Answer 4

CHF - 1
HTN (or treated) - 1
Age >= 75 - 2
Aged 65-74 - 1
Diabetes - 1
Prior stroke/TIA - 2
Vascular disease (IHD/PAD) - 1
Sex (female) - 1

Question 5

Patients on warfarin undergoing emergency surgery…

Answer 5

Four-factor prothrombin complex concentrate

Question 6

Transporter affected in Gitelman’s syndrome (salt-wasting nephropathy)

Answer 6

NaCl transporter in DCT

Question 7

Hypothermia ECG changes

Answer 7

J waves (small bumps at end of QRS)

Question 8

Hemiballism features

Answer 8

Involuntary sudden jerking movements

Question 9

Hemiballism lesion location

Answer 9

Subthalamic nucleus (contralateral to features)

Question 10

Hypercalcaemia on ECG

Answer 10

Shortened QT

Question 11

Migraine prophylaxis treatment (if having 2+ attacks per month)- 1st line

Answer 11

Topiramate or propranolol

Question 12

GLP-1 mimetic examples

Answer 12

Exenatide

Liraglutide

Question 13

GLP-1 mimetic side effects

Answer 13

Nausea and vomiting
(Exenatide linked to pancreatitis)

Weight loss!

Question 14

GLP-1 mimetic actions

Answer 14

Increase insulin secretion

Inhibit glucagon secretion

Question 15

DPP-4 inhibitor examples

Answer 15

Sitagliptin, vildagliptin

Question 16

DPP-4 inhibitor actions

Answer 16

Inhibit breakdown of GLP-1

Question 17

Sulfonylurea side effects

Answer 17

Hypoglycaemic episodes
(recurrent hypoglycaemia)

Weight gain

Question 18

Sulfonylurea actions

Answer 18

Increase pancreatic insulin secretion

Question 19

Pendred syndrome

Answer 19

Mild hypothyroidism + goitre
Bilateral sensorineural deafness

Autosomal recessive

Question 20

Treatment for viridans endocarditis

Answer 20

Benzylpenicillin

If pen allergic - vancomycin + low-dose gentamicin

Question 21

Treatment for staphylococcal prosthetic valve endocarditis

Answer 21

Flucloxacillin + rifampicin + low-dose gentamicin

Question 22

Treatment for staphylococcal native valve endocarditis

Answer 22

Flucloxacillin

If pen-allergic or MRSA - vamcoycin + rifampicin

Question 23

Infective endocarditis (native valve)- initial blind therapy

Answer 23

Amoxicillin (+ low-dose gentamicin)

Question 24

Infective endocarditis (prosthetic valve) - initial blind therapy

Answer 24

Vancomycin + rifampicin + low-dose gentamicin

Question 25

Ambrisentan

Answer 25

endothelin-1 receptor antagonist

Question 26

Expressive aphasia lesion location

Answer 26

Broca’s area = inferior frontal gyrus = posterior frontal lobe

Question 27

Receptive aphasia lesion location

Answer 27

Wernicke’s area = temporal lobe

Question 28

Causes of a loud S2

Answer 28

• HTN: systemic (loud A2) or pulmonary (loud P2)

- hyperdynamic states

Question 29

Causes of a soft S2

Answer 29

aortic stenosis

Question 30

Causes of fixed split S2

Answer 30

ASD

Question 31

Causes of wide split S2

Answer 31

Deep inspiration
RBBB
Pulmonary stenosis
Severe mitral regurgitation

Question 32

Causes of reverse split S2 (P2 occurs before A2)

Answer 32

LBBB
Severe aortic stenosis
PDA
WPW type B
R ventricular pacing

Question 33

Eisenmenger’s syndrome

Answer 33

The reversal of a left-to-right shunt

Question 34

Furosemide action

Answer 34

Inhibition of Na/K/Cl co-transporter in thick ascending limb

Question 35

SGLT-2 inhibitor action

Answer 35

Inhibit sodium-glucose co-transporter 2 in the proximal convoluted tubule, to reduce glucose reabsorption

Question 36

SGLT-2 inhibitor examples

Answer 36

empagliflozin

dapagliflozin

Question 37

MSRA bacteraemia treatment

Answer 37

Vancomycin + Rifampicin