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MRCP Flashcards

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1
Q

Wilcoxon signed-rank test

Parametric or non-parametric data

A

Non-parametric

compares two sets of observations on a single sample

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2
Q

Which drugs can cause cirrhosis (3)

A

methotrexate
methyldopa
amiodarone

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3
Q

Inheritance of Ocular albinism

A

X-linked recessive

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4
Q

What is the antibiotic regime of choice for pseudomonas in CF

A

Ceftazidime and tobramycin

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5
Q

What drug decreases concentration of Li

A

Acetazolamide & osmotic diuretics

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6
Q

Which GN typically present with nephritic syndrome (2)

A

Typically presents with nephritic syndrome (haematuria, hypertension)

Rapidly progressive glomerulonephritis - aka crescentic glomerulonephritis
Rapid onset, often presenting as acute kidney injury
causes include Goodpasture’s, ANCA positive vasculitis and SLE

IgA nephropathy - aka Berger’s disease, mesangioproliferative GN
typically young adult with haematuria following an URTI

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7
Q

When are steroids not indicated first line, for GN?

A

Membranous - tx with BP control and ACEi
Membranoproliferative - steroids are ineffective; can use eculizumab
Diffuse proliferative (post-strep) - self limiting

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8
Q

What are the driving restrictions for syncope (4)

A

Simple faint: no restriction
single episode, explained and treated: 4 weeks off
single episode, unexplained: 6 months off
two or more episodes: 12 months off

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9
Q

ANP is mainly secreted by the L or R atrium

A

Right atrium

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10
Q

Docetaxel
MOA
SE

A

MOA: antimicrotubule agent; Prevents microtubule depolymerisation and disassembly, decreasing free tubulin
SE: Neutropaenia

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11
Q 
Glossopharyngeal nerve (IX)
Vagus nerve (X)
Accessory nerve (XI)
Posterior meningeal artery
Ascending pharyngeal artery
Inferior petrosal sinus
Sigmoid sinus
Internal jugular vein

Which skull foramen

A

Jugular foramen

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12
Q

Bronchial malignancy is associated with which skin disorder

A

Erythema gyratum repens
Erythematous scaling rash over the abdomen
Wood grain appearance

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13
Q

Iron-deficiency anaemia - cells seen on microscopy (2)

A

target cells

‘pencil’ poikilocytes

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14
Q

Which anti TB drug is most likely to cause drug-induced lupus

A

procainamide
hydralazine
Isoniazid

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15
Q

Vincristine, vinblastine
MOA
SE

A

MOA: antimicrotubule agents; Inhibits formation of microtubules - act in mitosis phase of cell cycle
SE: Vincristine: Peripheral neuropathy (reversible) , paralytic ileus
Vinblastine: myelosuppression

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16
Q

Paraneoplastic syndromes - Anti-Hu
Associated with (2)
CF (3)

A

Associations: small cell lung carcinoma and neuroblastomas

CF
sensory neuropathy - may be painful
cerebellar syndrome
encephalomyelitis

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17
Q

Histiocytosis X is a cause of cranial or nephrogenic DI

A

Cranial

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18
Q

6-mercaptopurine
MOA
SE

A

MOA: antimetabolite; Purine analogue that is activated by HGPRTase, decreasing purine synthesis
SE: Myelosuppression

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19
Q

IFN-gamma
Function
Indications (2)

A

Produced by T lymphocytes and NK cells
Weaker antiviral action, more of a role in immunomodulation particularly macrophage activation
Chronic granulomatous disease and osteopetrosis

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20
Q

Secretin
Released by which cells
Stimulus
Effect

A

S cells

Acidic chyme and fatty acids

Increases pancreatic secretions and hepatic duct cells.
Decreases gastric acid secretion
Trophic effect on pancreatic acinar cells

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21
Q

Inheritance of Lesch-Nyhan syndrome

A

X-linked recessive

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22
Q

Mann-Whitney U test
What does it test
Parametric or non-parametric data

A

Non-parametric

Unpaired data

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23
Q

Inheritance of Von Willebrand’s disease (types 1 and 2) type 3

A

1 and 2 -> AD; 3 -> AR

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24
Q

What is the bug in cat scratch fever

What is the tx

A

Bartonela hensalae
Immunocompetent - supportive tx
Systemic disease - cipro

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25
Q

What is increased in lead poisoning

A

Urinary coproporphyrin

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26
Q

What are the features of cubital tunnel syndrome

Which nerve is involved

A

Ulnar nerve
Tingling in ulnar nerve distribution; weakness is late
Worse when elbow is resting on a surface or the arm is flexed

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27
Q

When are steroids indicated first line, for GN?

A

Minimal change disease
FSGS
IgA / mesangioproliferative
Rapidly progressive

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28
Q

Causes of a false positive VDRL test (4)

A

‘SomeTimes Mistakes Happen’ (SLE, TB, malaria, HIV)

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29
Q

commonest SE of nicorandil

A

ulceration

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30
Q

complication of pcp

A

pneumothorax

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31
Q 
Wilson's disease
Gene defect, chromosome and inheritance
Effects
Serum caeruloplasmin is high/low
Serum copper is high/low
Urinary Cu excretion is high/low
A

AR inheritance of ATP7B gene on chr13
Cu deposition in basal ganglia, eyes and liver
Reduced serum caeruloplasmin
Reduced serum copper (counter-intuitive, but 95% of plasma copper is carried by ceruloplasmin)
Urinary copper excretion - Increased

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32
Q

When should anticoagulation be started for an ischaemic stroke with AF

A

2 weeks

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33
Q

What tumour markers is elevated in teratoma / non-seminiferous testicular cancer

A

AFP & HCG

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34
Q

Indications for IFN-b

A

Relapsing remitting MS

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35
Q

IL-3
Source:
Effect:

A

Source: Activated T helper cells
Effect: Stimulates differentiation and proliferation of myeloid progenitor cells

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36
Q

Schizophrenics typically do or do not have insight into their condition

A

Not

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37
Q

when does the risk of neutropenic sepsis peak

A

10 days

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38
Q

What is the side effect of zanamivir

A

Bronchospasm

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39
Q

Tx of HSV (3)

A

Gingivostomatitis: oral aciclovir, chlorhexidine mouthwash
Cold sores: topical aciclovir although the evidence base for this is modest
Genital herpes: oral aciclovir. Some patients with frequent exacerbations may benefit from longer term aciclovir

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40
Q

IFN-alpha
Function
Indications (5)
SE

A

Produced by leucocytes
Antiviral action
Hepatitis B and C, Kaposi’s sarcoma, metastatic renal cell cancer, hairy cell leukaemia
Flu-like symptoms and depression

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41
Q 
Homocystinuria
Inheritance 
Enzyme defect
CF
Tx
A

AR
Deficiency of cystathionine beta synthase -> accumulation of homocysteine

CF:
Fine, fair hair
Marfanoid
Learning difficulties, seizures
Downwards (inferonasal) dislocation of lens

Pyridoxine (50% respond)

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42
Q

t(11;14) disease and mechanism

A 
Mantle cell lymphoma 
Cyclin D1 (BCL-1) deregulation
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43
Q

When is omalizumab indicated

A

Pts with severe allergic asthma who have required >4 courses of steroids in the past month

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44
Q

Drugs which can precipitate myasthenia crisis

A

Beta-blockers
Penicillamine, Quinidine, procainamide, Li, Phenytoin
Abx: gentamicin, macrolides, quinolones, tetracyclines

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45
Q

Histology of IgA nephropathy

A

LM - Mesangial cell proliferation

IF - Granular IgA and C3 deposition in the mesangium

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46
Q

How is gestational DM treated

A

If fasting glucose <7 -> trial diet & exercise; add metformin if not controlled after 1-2wks; add insulin if still not controlled
If glucose >7 at dx or >6 with sx -> insulin
Glibenclamide can be used if metformin is insufficient but insulin refused

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47
Q

Loss of which protein in nephrotic syndrome increases the risk of thrombosis

A

Antithrombin III

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48
Q

CREST is associated with which antibody

A

Anti-centromere

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49
Q

Tx for Mycobacteria avium

A

rifampicin, ethambutol & azithromycin

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50
Q

GFR increases or decreases during pregnancy

A

Increases

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51
Q

What are the two kinds of serological test in syphilis

A 
cardiolipin tests (not treponeme specific)
treponemal specific antibody tests
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52
Q

What antibiotics risk worsening G6PDD

A

quinolone (cipro) and nitrofurantoin

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53
Q

What is the tx of tapeworm infection (Taenia)

A

praziquantel or niclosamide

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54
Q

Which gene mutation is likely to exist in essential thrombocythaemia once JAK2 is excluded

A

Calreticulin

ET in around 20% of JAK-2 negative patients.

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55
Q

Bladder cancer is associated with what industry and what within it

A

Dyes industry. Rubber and leather industry

Aromatic amines

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56
Q

What does the SeHcat test, test for

A

Bile acid malabsorption

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57
Q

CCK
Released by which cells
Stimulus
Effect

A

L cells of upper small intestine

Partially digested proteins and TGs

Increases pancreatic secretions, GB contraction & relaxation of the sphincter of Oddi
Decreases gastric emptying
Trophic effect on pancreatic acinar cells
Induces satiety

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58
Q

What proportion of values lie within 1SD, 2SD and 3SD of the mean

A
  1. 3% of values lie within 1 SD of the mean (14)
  2. 4% of values lie within 2 SD of the mean (14)
  3. 7% of values lie within 3 SD of the mean (18)
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59
Q

Valproate

MOA and SE

A

GABA agonist
Weight gain
Nausea

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60
Q

SE of ciclosporin

A

Everything is increased - fluid, BP, K+, hair, gums, glucose

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61
Q

What is the mode of renal toxicity of gentamicin

A

Proximal tubule dysfunction

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62
Q

Ix for stable angina: 1, 2 and 3

A

CT coronary angiography - lumenal flow
Non-functional imaging - MRI, stress echo
Invasive coronary angiography

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63
Q

Which group of antibiotics are associated with exacerbations of myasthenia

A

Aminoglycosides

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64
Q

When should ciclosporin levels be taken

A

Trough dose - immediately before the next dose

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65
Q

Amyloidosis
What is the classification
What causes each

A

AL - primary (AL is alone - 1°)
Myeloma, Waldenstrom’s, MGUS
features include: cardiac and neurological involvement, macroglossia, periorbital eccymoses

AA - secondary - acute phase reactant
seen in chronic infection/inflammation
e.g. TB, bronchiectasis, rheumatoid arthritis
features: renal involvement most common feature

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66
Q

Driving restrictions

AAA

A

> 6cm -> notify DVLA; will have annual r/v

>6.5cm -> disqualifies patients from driving

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67
Q

Poor prognostic features in AML

A

> 60 years
20% blasts after first course of chemo
cytogenetics: deletions of chromosome 5 or 7

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68
Q

What is the treatment for schistosomiasis

A

Praziquantel

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69
Q

What monitoring is required for those on hydroxychloroquine

A

Annual eye assessment

Hydroxychloroquine can cause a retinopathy

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70
Q

Raltegravir

MOA

A

Integrase inhibitor

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71
Q

What are the 5 stages of lung changes in sarcoid

A

Stage 0 - normal CXR
Stage 1 - BHL only
Stage 2 - BHL & pulmonary infiltrates
Stage 3 - Diffuse pulmonary infiltrates only
Stage 4 - widespread fibrosis

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72
Q

Which drug post MI has the best effect on survival / lowers NNT

A

ACEi

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73
Q

Does a high or low phosphate predispose to pseudogout

A

Low

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74
Q 
Churg Strauss
What is it
What antibody is positive
CF
What drug can precipitate an attack
A

Small/medium vessel vasculitis
pANCA
Asthma, mononeuritis multiplex and eosinophilia
Leukotriene receptor antagonists can worsen the disease (montelukast)

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75
Q

What drug is added 2nd line in those still sx with gout despite maximal allopurinol tx

A

Benzbromarone

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76
Q

What are the associations of thymoma (5)

A 
Madras:
Myasthenia
Dermatomyositis
Red cell aplasia
SLE
SIADH
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77
Q

IL-6
Source:
Effect:

A

Source: Macrophages, Th2 cells
Effect:
Stimulates differentiation of B cells
Induces fever

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78
Q

Polyglandular autoimmune syndrome type 1
Gene defect
Conditions within
Also known as

A

AR mut AIRE1 gene, chr 21
Addison’s disease; chronic mucocutaenous candidiasis; HypoPTHism
MEDAC - Multiple Endocrine Deficiency Autoimmune Candidiasis

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79
Q

Broca’s area
Where is it
What does it do
What effect does a stroke in this area have

A

Inferior frontal gyrus - left frontal lobe
Causes expressive dysphasia
Difficulty with fluency - poor repetition

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80
Q

When are steroids not indicated first line, for GN?

A

Membranous - tx with BP control & ACEi
Membranoproliferative - steroids are ineffective; can use eculizumab
Diffuse proliferative (post-strep) - self limiting

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81
Q

anti dsDNA antibodies are associated with which disease

A

SLE - specificity 99%; sensitivity 70%

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82
Q

Hyposplenism - cells seen on microscopy (3)

A

Target cells
Howell-Jolly bodies
Pappenheimer bodies

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83
Q

Histology of minimal change disease

A

Light microscopy - no change
EM - effacement of podocyte foot processes; thickening of GBM
IF - no immune deposits

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84
Q

Where are antibodies directed against in bullies pemphigoid

A

Hemidesmosomes BP180 and 230

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85
Q

Which clotting factor in paradoxically increased in liver failure?

A

FVIII

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86
Q

IL-2
Source:
Effect:

A

Source: Th1 cells
Effect: Stimulates growth and differentiation of T cell response

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87
Q

Inheritance of Wiskott-Aldrich syndrome

A

X-linked recessive

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88
Q

Secondary causes of hyper-TGaemia

A

Hypertriglyceridaemia:
Diabetes mellitus (types 1 and 2) - Disproportionately high VLDL and low HDL
Obesity
Alcohol
Chronic renal failure
Drugs: thiazides, non-selective beta-blockers, unopposed oestrogen, immunosuppressants
Liver disease
Asian diabetics - tend to have low HDL and raised TGs

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89
Q

IFN-beta
Function
Indications

A

Produced by fibroblasts
Antiviral action
MS - reduces the frequency of exacerbations

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90
Q

Variceal bleed - is banding or sclerotherapy first line

A

Banding

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91
Q

What is the commonest associated symptom with Waldenstroms macroglobulinaemia

A

generliased weakness

Other facts:
Raised IgM
Hepatosplenomegaly
Sx of hyperviscosity

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92
Q

Which body part is acne rosecea also associated with

A

Eyes - blepharitis, keratitis, conjunctivitis

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93
Q

What is the mx of a myasthenic crisis

A

plasmapheresis or IV Ig

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94
Q

Which drugs can cause hepatocellular damage / hepatitis (10)

A 
Paracetamol
Anti-convulsants - sodium valproate, phenytoin
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
nitrofurantoin
MAOIs
halothane
amiodarone
methyldopa
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95
Q

Driving restrictions

CABG

A

CABG - 4 weeks off driving

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96
Q

Association of HLA-A3

A

haemochromatosis

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97
Q

For how long after a prosthetic valve replacement does staph epidermidis remain the most likely bug in IE, before staph aureus becomes more likely

A

2 months

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98
Q

Which vaccine should absolutely be avoided in HIV

A

BCG

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99
Q

What antibodies are present in paraneoplastic pemphigus

A

Anti-(…)plakins eg envoplakin

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100
Q

Erythema nodosum is a good or bad prognostic feature of sarcoid

A

Good

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101
Q

Inheritance of Kallman’s syndrome

Presents with undescended testes or not

A

X-linked recessive

Undescended testes -> much more likely Kallman’s than Klinefelters

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102
Q

What is the treatment for narcolepsy & cataplexy

A

Modafinil

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103
Q

Which drugs can precipitate acute glaucoma

A

Amitriptyline and anticholinergics

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104
Q

Which cytokines to Th2 cells secrete (4)

A

involved in mediating humoral (antibody) immunity
e.g. stimulating production of IgE in asthma
secrete IL-4, IL-5, IL-6, IL-10, IL-13

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105
Q

Second line choice of antibiotic in suspected meningitis when penicillin / cephalosporin contraindicated

A

Chloramphenicol

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106
Q

BP targets
Age
DM
CKD

A

<140/90 if <80yrs (clinic) or <135/85 (home);
<150/95 if >80yrs

DM
<130/80 if end organ damage;
Otherwise <140/80

Chronic renal disease
<125/75

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107
Q

IL-4
Source:
Effect:

A

Source: Th2 cells
Effect: Stimulates proliferation and differentiation of B cells

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108
Q

where are antibodies found in pemphigus vs pemphigoid

A

pemphigus - within the epidermis

pemphigoid - at the dermo-epidermal junction

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109
Q

Paroxysmal nocturnal haemoglobinuria is associated with what cell markers
what is the classic triad

A

CD and CD59 negative cells

Haemoglobinuria, pancytopenia, venous thrombosis

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110
Q

Inheritance of Hereditary haemorrhagic telangiectasia

A

AD

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111
Q

Indications for haemodialysis in methanol poisoning

A

Low GCS
Visual impairment
Severe poisoning - Level >0.5g/L
Renal impairment

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112
Q

What is the treatment for TTP

A

Plasma exchange with protein replacement

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113
Q

Which cell surface receptor allows entry of P. vivax, and is absent in West African populations, causing resistance

A

Duffy

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114
Q

Abciximab

MOA

A

Glp IIb / IIIA inhibitor

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115
Q

Which GN typically present with nephritic syndrome (2)

A

Typically presents with nephritic syndrome (haematuria, hypertension)

Rapidly progressive glomerulonephritis - aka crescentic glomerulonephritis
Rapid onset, often presenting as acute kidney injury
causes include Goodpasture’s, ANCA positive vasculitis and SLE

IgA nephropathy - aka Berger’s disease, mesangioproliferative GN
typically young adult with haematuria following an URTI

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116
Q

What factors predispose to pseudogout?
3 electrolytes
4 conditions

A 
Hyper-Ca (hyper-PTHism)
Low Mg 
Low phosphate
Hypothyroidism
Haemochromatosis, acromegaly, Wilson's disease
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117
Q

Visceral leishmaniasis
species
Tx

A

L. donovani

Amphotericin B

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118
Q

VHL predisposes to what tumours / sites - 8
What is the commonest cause of death
Which chromosome

A 
Cerebellar, brainstem and spinal haemangioblastomas 
Retinal angiomas
Phaeochromocytomas
Paragangliomas
Renal cysts and clear cell carcinoma
Pancreatic cysts and islet cell tumours
Epidydimal tumours
Endolymphatic tumours

Renal carcinoma is commonest cause of death

Chr 3

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119
Q

Inheritance of Von Willebrand’s disease (types 1 and 2) and type 3

A

1 and 2 -> AD; 3 -> AR

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120
Q

Inheritance of Fabry’s disease

A

X-linked recessive

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121
Q

Test for phaeochromocytoma

A

urinary vanillylmendelic acid and plasma metanephrines

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122
Q

Which antibody is positive in mixed connective tissue disease

A

anti RNP

Features of SLE, systemic sclerosis and polymyositis

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123
Q

Which drugs can cause cholestasis (6)

A

oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates

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124
Q

Which kinds of diuretics are associated with hypo-Mg
Thiazide
Loop
K-sparing

A

Thiazide - yes
Loop - yes
K-sparing - no

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125
Q

What are the transplant criteria for paracetamol OD

A

pH <7.3

Or all 3 of:
Creatinine >300
PT >100
Grade 3/4 encephalopathy

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126
Q

Doxorubicin
MOA
SE

A

MOA: Cytotoxic; Stabilizes DNA-topoisomerase II complex inhibits DNA and RNA synthesis
SE: Cardiomyopathy

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127
Q

Lofgren’s syndrome

What is it

A 
Acute sarcoid with: 
Erythema nodosum
Arthralgia
Acute anterior uveitis
Fever
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128
Q

How are DOACs measured

A

PT

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129
Q

Inheritance of Hereditary spherocytosis

A

AD

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130
Q

MODY5
HNF-1b gene mutation
Pancreatic atrophy & renal cysts

A

x

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131
Q

Features of yellow nail syndrome (5)

A 
Yellow nails
Bronchiectasis
Congenital lymphedema 
Pleural effusions
Chronic sinusitis
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132
Q

What condition is associated with quadriceps muscle weakness and weakness of finger flexors

A

Inclusion body myositis

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133
Q

LRTI with what can cause reactivation of HCV cold sores

A

Strep pneumo

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134
Q

When should Li levels be taken

A

12hrs post dose

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135
Q

Which cyclins and CDKs are active in G2 phase of cell cycle

A

Cyclin B and CDK1

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136
Q

Bupropoion
MOA
SE

A

a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

Reduces seizure threshold - CI in epilepsy & bipolar

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137
Q

What are the commonest primary malignancies for those presenting with bone mets

A

Breast & lung - 80%

Remaining 20% - incl kidney, thyroid

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138
Q

Below which LVEF are HGV licences (Group 2) not allowed

A

40%

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139
Q

IFN-alpha
Function
Indications (5)
SE

A

Produced by leucocytes
Antiviral action
Hepatitis B & C, Kaposi’s sarcoma, metastatic renal cell cancer, hairy cell leukaemia
Flu-like symptoms and depression

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140
Q

Doxorubicin
Class of drug
MOA
SE

A

Anthracycline
MOA: Cytotoxic; Stabilizes DNA-topoisomerase II complex inhibits DNA and RNA synthesis
SE: Cardiomyopathy

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141
Q

MODY5
What is the mutation
CF
tx

A

HNF-1b gene mutation
Pancreatic atrophy & renal cysts
Usually responsive to sulfonylureas - insulin not usually necessary.

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142
Q

Causes of occupational asthma (7)

I pretend some girls fancy early penetration

A 
isocyanates - commonest cause. Example occupations include spray painting and foam moulding using adhesives
platinum salts
soldering flux resin
glutaraldehyde
flour
epoxy resins
proteolytic enzymes
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143
Q

Neuropathic pain - 1st, 2nd and 3rd line mx

A

1st - pregabalin, gabapentin, duloxetine, amitriptyline
2 - add one of the other first line agents
3 - tramadol

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144
Q

What tx can be added to a PD pt suffering dyskinesia with L-Dopa & DA agonists
MOA

A

Amantadine

Antimuscarinic & NMDA-R antagonist

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145
Q

What is the specific effect of metformin

A

Reduces hepatic glucose output

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146
Q

How does phenytoin cause a macrocytosis

A

Altered folate metabolism

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147
Q

What is the minimum steroid intake a patient should be taking before they are offered osteoporosis prophylaxis?

A

7.5mg / day for 3mths

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148
Q

Inheritance of G6PD deficiency

A

X-linked recessive

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149
Q

Inheritance of Malignant hyperthermia

A

AD

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150
Q

Inheritance of Di George syndrome

A

AD - microdeletion of TBX1 on chr 22

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151
Q

Drugs associated with thrombocytopenia (7)

A

quinine
abciximab
NSAIDS
diuretics: furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin

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152
Q 
Churg Strauss
What is it
What antibody is positive
CF
What drug can precipitate an attack
A

Small/medium vessel vasculitis
pANCA
Asthma, mononeuritis multiplex and eosinophilia
Leukotriene receptor antagonists can worsen the disease (montelukast)

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153
Q

What proportion of values lie within 1SD, 2SD & 3SD of the mean

A
  1. 3% of values lie within 1 SD of the mean (14)
  2. 4% of values lie within 2 SD of the mean (14)
  3. 7% of values lie within 3 SD of the mean (18)
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154
Q

Tx regimes for malaria

A

Falciparum - complicated
ACT - Riamet & Malarone

Falciparum - uncomplicated
Quinine and doxycycline

Non-falciparum
Chloroquine and primaquine

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155
Q

Arcuate fasciculus
What does it do
What effect does a stroke in this area have

A

Connects Brocas and Wernickes areas

Stroke causes a fluent dysphasia, mimicking Broca’s

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156
Q

Inheritance of Hunter’s disease

A

X-linked recessive

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157
Q

How is gestational DM treated

A

If fasting glucose <7 -> trial diet and exercise; add metformin if not controlled after 1-2wks; add insulin if still not controlled
If glucose >7 at dx or >6 with sx -> insulin
Glibenclamide can be used if metformin is insufficient but insulin refused

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158
Q

Tenofovir

A

Nucleotide RTI

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159
Q

What are the predominant features of visceral leishmaniasis

A

fever, widespread lymphadenopathy, hepatosplenomegaly, organ dysfunction
Pancytopaenia
Abnormal LFTs

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160
Q

Inheritance of PKU

A

AR

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161
Q

Alpha haemolytic strep infective endocarditis tx

A

Benpen & gent

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162
Q

What effect does bradykinin have on the airways

A

Bronchoconstriction

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163
Q

von Willebrands disease - bleeding time prolonged or normal

A

prolonged

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164
Q

Ix of choice for avascular necrosis

A

MRI

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165
Q

Inheritance of Cystinuria

A

AR

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166
Q

Myelofibrosis - cells seen on microscopy (1)

A

‘tear-drop’ poikilocytes

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167
Q

What are the causes of FSGS (6)

A 
1° - idiopathic
2° to other renal pathology e.g. IgA nephropathy, reflux nephropathy
HIV
heroin
Alport's syndrome
sickle-cell
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168
Q

Inheritance of ataxia telangiectasia

A

Autosomal recessive

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169
Q

Which anticonvulsants do not interact with P450

A

Lamotrignine, Levetiracetam (the Ls are Level)

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170
Q

Which antibody test has the best negative predictive value for SLE

A

ANA

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171
Q

What are the commonest electrolyte imbalances in reseeding syndrome

A

hypophosphataemia -> heart failure and skeletal muscle weakness
hypokalaemia
hypomagnesaemia

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172
Q

primarily malabsorptive bariatric procedure

A

Biliopancreatic diversion with duodenal switch

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173
Q

What are first and second line for the treatment of bipolar disorder

A

1 - Valproate

2 - Li

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174
Q

what is the first line tx for threadworm

A

mebendazole

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175
Q

Contraindication to pneumonectomy

A

FEV1 <2L

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176
Q

Wire looping of capillaries in the glomeruli is seen in which glomerulonephrtis

A

Diffuse proliferative glomerulonephritis (often due to SLE).

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177
Q

Raltegravir, elvitegravir, dolutegravir

MOA

A

Integrase inhibitors

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178
Q

Inheritance of Lipid storage disease: Tay-Sach’s, Gaucher, Niemann-Pick

A

AR

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179
Q

Malignancies cause what kind of GN

A

Membranous - malignancy

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180
Q

IL-10 (human cytokine synthesis inhibitory factor):
Source:
Effect:

A

Source: Th2 cells
Effect: Inhibits Th1 cytokine production - anti-inflammatory

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181
Q

What antibiotic can reduce the renal clearance of Li (2)

What other drugs

A 
metronidazole &amp; tetracyclines
NSAIDs
steroids
thiazide &amp; loop diuretics 
ACEi / ARB
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182
Q

Combining pioglitazone with what, increases the risk of peripheral oedema (CI in HF)

A

Insulin

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183
Q

What drug is used to treat gastroparesis in T1DM

A

Domperidone

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184
Q

BPPV
Dix-Hallpike manoeuvre and Epley manoeuvre
Which is therapeutic and which diagnostic

A

Dix-Hallpike manoeuvre - dx

Epley manoeuvre - therapeutic

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185
Q

Associations of coarctation of the aorta (4)

A

Turner’s syndrome
bicuspid aortic valve
berry aneurysms
neurofibromatosis

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186
Q

Absorption of which drug is impaired by calcium carbonate

A

Levothyroxine

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187
Q

What are the acute SE of phenytoin (3-4)

A

Cerebellar sx - ataxia, slurred speech, dizziness
Diplopia
Nystagmus
+/- confusion and seizures

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188
Q

95% of samples lie within how many SD of the mean

A

1.96 SD of the mean lie 95% of the sample values

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189
Q

Superior orbital fissure

What leaves via this foramen (6)

A

Superior ophthalmic vein
Inferior ophthalmic vein

Oculomotor nerve (III)
Trochlear nerve (IV)
lacrimal, frontal and nasociliary branches of ophthalmic nerve (V1)
Abducent nerve (VI)
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190
Q

two main modes of paracetamol metabolism

A

glucoronic acid conjugation & sulphation

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191
Q

What is the driving restriction post first unprovoked/isolated seizure (2)

A

6 months - if no structural abnormalities on brain imaging and no definite epileptiform activity on EEG
Otherwise 12 months

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192
Q

IHD and AF - what is the anticoagulation guideline

A

If stable IHD -> oral anticoagulation only
If recent PCI / ACS -> 6mths of dual anti-plt tx with oral anticoagulation, then single antiplt oral anticoagulation until 12mths

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193
Q

Above what cd4 count in HIV should live vaccines of MMR, yellow fever and chickenpox be given

A

200

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194
Q

t(15;17) disease and mechanism

A

Acute promyelocytic leukaemia (M3)

PML and RAR fusion

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195
Q

What are the indications for surgery in primary hyper-PTHism (5)

A 
Age <50 years.
Ca > 2.85
gfr <60
Complications of hyper-Ca - stones, nephrocalcinosis, osteoporosis or osteoporotic fracture.
Symptomatic disease
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196
Q

Indications for orlistat

A

BMI >30
BMI >28 if associated complications
>5% weight loss in 3mths

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197
Q

What is first line tx for CMV

A

ganciclovir

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198
Q

commonest GI problem in SLE

A

Mouth ulcers

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199
Q

What drugs can be cleared by haemodialysis (5)

What drugs cannot (5)

A

Drugs that can be cleared with haemodialysis - mnemonic: BLAST
Barbiturate
Lithium
Alcohol (inc methanol, ethylene glycol)
Salicylates
Theophyllines (charcoal haemoperfusion is preferable)

Drugs which cannot be cleared with haemodialysis include
tricyclics
benzodiazepines
dextropropoxyphene (Co-proxamol)
digoxin
beta-blockers
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200
Q

t(15;17) - disease and mechanism

A

Acute promyelocytic leukaemia (M3)

PML and RAR fusion

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201
Q

When should an LP be done post headache onset in SAH to exclude a bleed

A

12hrs

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202
Q

First line tx for SVC obstruction

A

Stenting esp if solid tumour

Steroids more useful for haematological malignancy

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203
Q

Which factors contribute to the MDRD calculation of gfr

A

CAGE - serum creatinine, age, gender, ethnicity

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204
Q

What kind of gallstones are most likely to be found in states of raised haemolytic eg HS

A

Black pigment stones - radiolucent

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205
Q

IL-2
Source:
Effect:

A

Source: Th1 cells
Effect: Stimulates growth and differentiation of T cell response

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206
Q

What is the prevalence of RA?

A

1%

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207
Q

What is the conversion ratio between oral MST / morphine sulphate and parenteral (sc, iv, im)

A

Halve the dose

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208
Q

Associated with breast, colorectal and small cell lung carcinoma
stiff person’s syndrome or diffuse hypertonia

A

Anti-GAD antibody

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209
Q

Which type of glomerulonephritis is most characteristically associated with partial lipodystrophy?

A

Mesangiocapillary GN type 2

Mesangiocapillary glomerulonephritis (membranoproliferative)
type 1: cryoglobulinaemia, hepatitis C
type 2: partial lipodystrophy
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210
Q

Which anti TB drugs should be avoided / reduced in renal impairment (2)

A

Ethambutol and streptomycin

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211
Q

Bupropoion

A

x

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212
Q

What is the effect of C5 deficiency

A

Predisposes to Leiner disease

recurrent diarrhoea, wasting and seborrhoeic dermatitis

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213
Q

IL-10 (human cytokine synthesis inhibitory factor):
Source:
Effect:

A

Source: Th2 cells
Effect: Inhibits Th1 cytokine production - anti-inflammatory

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214
Q

What drugs increase the risk of idiopathic intracranial htn

A

Vit A, OCP, steroids, tetracycline, Li

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215
Q

Felty’s syndrome
What is it
Blood

A

Triad of RA, neutropaenia and splenomegaly
Reticuloendothelial stimulation causes hypersplenism
Normochromic or hypo chromic anaemia

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216
Q

Gardner’s syndrome

CF - 4

A

Variant of FAP

Osteomas of the skull and mandible, retinal pigmentation, thyroid carcinoma and epidermoid cysts on the skin

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217
Q

Which GN are associated with low complement levels?

A 
Post strep GN
Mesangiocapillary GN
Subacute bacterial endocarditis GN
Cryoglobulinaemia
SLE
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218
Q

A1AT - inheritance and gene

A

AR or co-dominant inheritance

Chr 14

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219
Q

How often should Li levels be checked

A

3mthly

6mthly for U&E & TFT

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220
Q

Optic canal

What leaves via this foramen (2)

A

Optic nerve

Ophthalmic artery

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221
Q

VIP
Released by which cells
Stimulus
Effect

A

Released by small intestine & pancreas

Stimulus: neural

Stimulates secretion of water & intestinal smooth muscle relaxation
Inhibits acid secretion

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222
Q

What hormone triggers epiphyseal fusion

A

Oestrogen

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223
Q

Direct contact with left kidney

A

Left suprarenal gland
Pancreas
Colon

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224
Q

IL-8
Source:
Effect:

A

Source: Macrophages
Effect: Neutrophil chemotaxis

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225
Q

What are the irreversible features of haemochromatosis

A

Arthropathy
Diabetes
Liver cirrhosis
Hypergonadotrophic hypogonadism

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226
Q

Histology of FSGS

A

LM - focal and segmental sclerosis
EM - Thickening of GBM
IF - IgG and C3 deposition

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227
Q

Amphotericin B
MOA
SE

A

MOA: Binds ergosterol

SE: Nephrotoxicity, flu-like symptoms, electrolytes (hypokalaemia, hypomagnaseamia)

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228
Q

Management (1st and; 2nd line) tx of migraine in pregnancy

A

Migraine during pregnancy
paracetamol 1g is first-line
aspirin 300mg or ibuprofen 400mg can be used second-line in the first and second trimester

229
Q

Which viral meningitis is associated with a low CSF glucose

A

Mumps

230
Q

Direct contact with right kidney

A

Right suprarenal gland
Duodenum
Colon

231
Q

Pearson’s product-moment coefficient
Parametric or non-parametric data
What does it test

A

Parametric

Tests correlation

232
Q

Foramen ovale

A 
Mandibular nerve (V3)
Accessory meningeal artery
233
Q

Draw and label the JVP

A 
A - Atria contract
C - TV closes (c for close)
X - RV contracts
V - Atria contact against closed TV
Y - TV opens
234
Q

What are the causes of a decreased TLCO

A

R->L shunting
Pneumonia
Pulmonary emboli

Problems with the alveolar wall
Fibrosis
pulmonary oedema

Loss of lung tissue
emphysema

No blood
anaemia
low cardiac output

235
Q

When should digoxin levels be taken

A

6hrs post dose

236
Q

MODY2
What is the mutation
CF
tx

A

Mutation in glucokinase (glucose sensor in pancreatic beta cells)
Controlled with diet alone.

237
Q

Gold for RA

SE

A

Peripheral neuropathy
Nephrotic syndrome
Aplastic anaemia
Pulmonary fibrosis

238
Q

Ehlers Danlos syndrome
Inheritance
Which collagen is most often defective

A

AD

Collagen 3

239
Q

Causes of extravascular haemolysis

A

Haemoglobinopathies: sickle cell, thalassaemia
Hereditary spherocytosis
Haemolytic disease of newborn
Warm autoimmune haemolytic anaemia

240
Q

Histology of FSGS

A

LM - focal and segmental sclerosis
EM - Thickening of GBM
IF - IgG and C3 deposition

Second commonest GN cause of nephrotic syndrome in adults after membranous GN

241
Q

Hep B PEP
What are the 3 classes of responder
Unknown source

A

Unknown source:
Known responder to the vaccine, non-responder, currently being vaccinated
Known responders - booster dose of HBV vaccine.
Non-responders - HBIG + vaccine
Those in the process of being vaccinated - accelerated course of HBV vaccine

242
Q

MOA of antipsychotics eg olanzapine (2)

A

D2 antagonist

5HT-2 antagonist

243
Q

Dipyradimole

MOA

A

PDE inhibitor - non-specific

244
Q

Which drugs may exacerbate HF (5)

A

thiazolidinediones - pioglitazone - fluid retention
verapamil: negative inotropic effect
NSAIDs & glucocorticoids - fluid retention
class I antiarrhythmics - flecainide (negative inotropic and proarrhythmic effect)

245
Q

SLE is associated with deficiencies of which complement factors

A

C3 and 4

246
Q

A central scotoma points to a defect in which part of the optic pathway

A

Optic nerve

247
Q

Inheritance of Hyperlipidaemia type II

A

AD

248
Q

Ritonavir
P450 inhibitor or inducer
MOA

A

Inhibitor

Protease inhibitor

249
Q

Causes of a raised prolactin (the Ps)

A 
Pregnancy / physiological
Prolactinoma
polycystic ovarian syndrome
primary hypothyroidism
Drugs - phenothiazines, metoclopramide, domperidone
250
Q

MOA of ticagrelor

A

Plt ADP-R (P2Y12) inhibitor
Does not undergo hepatic activation - not vulnerable to p450 interaction, which clopidogrel is
Reversible allosteric block

251
Q

Indications for IV Ig (10)

A
  • primary and secondary immunodeficiency
  • low serum IgG levels following haematopoietic stem cell transplant for malignancy
  • pneumonitis induced by CMV following transplantation

•toxic epidermal necrolysis

idiopathic thrombocytopenic purpura
•Kawasaki disease
•dermatomyositis

  • myasthenia gravis
  • Guillain-Barre syndrome
  • chronic inflammatory demyelinating polyradiculopathy
252
Q

Which drugs can cause cholestasis (6)

A

SOAP SF
Steroids
oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
phenothiazines: chlorpromazine, prochlorperazine

sulphonylureas
fibrates

253
Q

Resistance to ARV drugs tends to be against what class

A

RTIs

254
Q

What is the test for hypopituitarism

A 
Combined pituitary function test
Including hypoglycaemia (<2.2) to stimulate ACTH and GH
255
Q

Spearman, Kendall rank

Parametric or non-parametric data

A

Non-parametric

Tests correlation

256
Q

SLE is associated with which antibody

A

anti dsDNA - specificity 99%; sensitivity 70%

257
Q

Which antibiotic can cause a peripheral neuropathy & optic neuritis

A

Nitrofurantoin

258
Q

What is the effect of C1 inhibitor (C1-INH) protein deficiency

A

Hereditary angioedema

259
Q

Renal failure in Alports post transplant is typically caused by

A

Anti GBM antibodies causing a goodpastures like picture

260
Q

Diffuse systemic sclerosis is associated with which antibody

A

Scl-70 antibodies

261
Q

Secretin
Released by which cells
Stimulus
Effect

A

S cells

Acidic chyme and fatty acids

Increases pancreatic secretions of bicarb from centriacinar cells and hepatic duct cells.
Decreases gastric acid secretion

262
Q

Indications for IFN-g

A

Chronic granulomatous disease

Osteopetrosis

263
Q

Inheritance of Myotonic dystrophy

A

AD

264
Q

Associated with small cell lung carcinoma and neuroblastomas
sensory neuropathy - may be painful
cerebellar syndrome
encephalomyelitis

A

Anti-Hu

265
Q

Ipilimumab

MOA

A

CTLA-4 inhibitor

266
Q

antibiotic of choice for legionnaire’s disease

A

quinolone

267
Q 
Leukocyte adhesion deficiency	
Which cell type is affected
Defect
Effect
Test
A

Neutrophil disorder
Defect of LFA-1 integrin (CD18) protein on neutrophils
Recurrent bacterial infections, Delay in umbilical cord sloughing
Absence of neutrophils/pus at sites of infection

268
Q

Saquinavir
P450 inhibitor or inducer
MOA

A

Inhibitor

Protease inhibitor

269
Q

IFN-gamma
Function
Indications (2)

A

Produced by T lymphocytes and NK cells
Weaker antiviral action, more of a role in immunomodulation particularly macrophage activation
Chronic granulomatous disease and osteopetrosis

270
Q

t(8;14) - disease and mechanism

A

Burkitt’s lymphoma

Myc - Ig

271
Q

Histology of FSGS

A

LM - focal and segmental sclerosis
EM - Thickening of GBM
IF - IgG and C3 deposition

272
Q

Which GN typically present with nephrotic syndrome

A

Typically presents with nephrotic syndrome (proteinuria, oedema)

Minimal change disease
typically a child with nephrotic syndrome (accounts for 80%)
causes: Hodgkin’s, NSAIDs
good response to steroids

Membranous glomerulonephritis
presentation: proteinuria / nephrotic syndrome / chronic kidney disease
cause: infections, rheumatoid drugs, malignancy
1/3 resolve, 1/3 respond to cytotoxics, 1/3 develop chronic kidney disease

Focal segmental glomerulosclerosis
may be idiopathic or secondary to HIV, heroin
presentation: proteinuria / nephrotic syndrome / chronic kidney disease

273
Q

What is Weber’s syndrome

What causes it

A

Ipsilateral third nerve palsy with contralateral hemiplegia -
Midbrain strokes

274
Q

Drugs causing retinopathy

A

Hydroxychloroquine

Vigabatrin

275
Q

What cytokine activates macrophages

What cell release it

A 
IFNg
Th1 cells (induced by IL12)
276
Q

Inheritance of Becker muscular dystrophy

A

X-linked recessive

277
Q

What is the inheritance of hypophosphataemic rickets

A

X-linked dominant

278
Q

Regimes in multiple myeloma

A

x

279
Q

Lamivudine, emtricitabine, epzicom, combivir, trizivir
Zidovudine (AZT)
zalcitabine, stavudine
Abacavir

MOA
SE

A

Nucleoside RTI

SE - peripheral neuropathy

280
Q

MODY2
What is the mutation
CF
tx

A

Mutation in glucokinase (glucose sensor in pancreatic beta cells)
Controlled with diet alone

281
Q

Association of HLA-DR2 (3)

A

narcolepsy
Goodpasture’s
SLE
MS

282
Q

Gastrin
Released by which cells
Stimulus
Effect

A

G cells in the duodenum & pyloric antrum

Gastric distension, luminal peptides, vagus nerve

Increases acid secretion from parietal cells, pepsinogen and intrinsic factor secretion
Stimulates maturation of parietal cells

283
Q

Contraindications to lung cancer surgery

A

SVC obstruction
FEV < 1.5
MALIGNANT pleural effusion
Vocal cord paralysis

284
Q

Premack principle

A

Less desired behaviours can be encouraged by use of a more desired reward
Often used in eating disorders

285
Q

Paroxysmal nocturnal haemoglobinuria is associated with what cell markers
and what is the classic triad

A

CD and CD59 negative cells

Haemoglobinuria, pancytopenia, venous thrombosis

286
Q

What are the features of an axonal polyneuropathy

What are the causes (5)

A

Axonal pathology - conduction speed not lost, but action potential is smaller

Alcohol
Diabetes mellitus (may also cause a demyelinating picture)
Vasculitis
Vitamin B12 deficiency (may also cause a demyelinating picture)
Hereditary sensorimotor neuropathies (HSMN) type II

287
Q

What is the 1st line DMARD for PsA

A

Methotrexate

288
Q

acute intermittent porphyria is due to a defect in which enzyme

A

Porphobilinogen synthase

289
Q

CLL causes what kind of autoimmune haemolytic anaemia

A

Warm AHA

290
Q

Cutaneous leishmaniasis
Species
Tx

A

L major/ mexicana / tropicana

Topical sodium stibogluconate

291
Q

MS - good prognostic factors (5)

A 
Female
Young onset
Sensory symptoms
Long gap between attacks
Relapsing remitting disease
292
Q

Student’s t-test

Parametric or non-parametric data

A

Parametric

293
Q

Complications of hepatitis B (6)

A 
Chronic hepatitis 
Liver failure 
HCC
Glomerulnephritis
Polyarteritis nodosa
Cryoglobulinaemia
294
Q

Histology of membranous GN

A

LM - thickening of GBM and capillaries
EM - Subepithelial deposits
IF - Granular IgG and C3 on outside of GBM

295
Q

Inheritance of Marfan’s syndromes

A

AD

296
Q

Which drugs can cause hepatocellular damage / hepatitis (10)

A 
Paracetamol
Anti-convulsants - sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin
297
Q

Thresholds for dx of DM

A

Fasting
>7 -> DM
6-7 -> IFG
<6 -> normal

OGTT
>11.1 -> DM
7.8-11.0 -> IFG
<7.8 -> normal

Random >11.1

298
Q

Which has more effect, R- or S-warfarin
Which p450 metabolises it
Which drug interacts

A

S-warfarin
2c9
Metronidazole - decreases metabolism of the more efficacious S-warfarin

299
Q

Goodpasture’s vs Wegener’s - which is more associated with a raised ESR

A

Goodpastures

300
Q 
Maxillary nerve (V2)
Which skull foramen
A

Foramen rotundum

301
Q

What are the risk factors for cataracts?

How are they classified (2)

A

Most are age related

Systemic
DM
Steroids
Infection - congenital rubella
Metabolic - hypo-Ca, galactosaemia
Conditions - myotonic dystrophy, Down's
Ocular
•trauma
•uveitis
•high myopia
•topical steroids
302
Q

Which cyclins and CDKs are active in G1 phase of cell cycle

A

Cyclin D and E; CDK 2,4,6

303
Q

What is the Haldane effect

A

Increase in pO2 means CO2 binds less well to Hb

304
Q

How are the causes of cataracts classified (2)

(i) 5
(ii) 4

A

Most are age related

Systemic
DM
Steroids
Infection - congenital rubella
Metabolic - hypo-Ca, galactosaemia
Conditions - myotonic dystrophy, Down's
Ocular
•trauma
•uveitis
•high myopia
•topical steroids
305
Q

Association of HLA-B27

A

ankylosing spondylitis
Reiter’s syndrome
acute anterior uveitis

306
Q

What are Gram positive rods

ABCD L

A 
Actinomyces
Bacillus
Clostridium
Corynebacterium diphtheria 
Listeria
307
Q

Varenicline

MOA

A

Nicotinic receptor partial agonist

308
Q

Drugs known to precipitate TEN/SJS (6)

A

Phenytoin, carbamazepine, penicillin, sulphonamides, NSAIDs, allopurinol
Tx with IVIg +/- immunosuppression (cyclophosphamide, ciclosporin) +/- plasmapheresis

309
Q

How is hep c confirmed

A

HCV RNA

310
Q

Inheritance of Alports disease

A

X linked dominant

10-15% are autosomal recessive

311
Q

What are used as prophylaxis in migraine

A

Topiramate

Propranolol

312
Q

naftidrofuryl

MOA

A

5HT2 antagonist

Used for intermittent claudication -> vasodilation

313
Q

How do you calculate OR

What sort of study generates an OR

A

Odds of intervention / odds of control

Odds = number with thing / number without thing

Case control - retrospective

314
Q

Association of HLA-DR3

A 
dermatitis herpetiformis
Sjogren's syndrome
primary biliary cirrhosis
Primary sclerosing cholangitis
T1DM
315
Q

What is the mutation that leads to carbapenem resistance

A

New Delhi metallo-beta-lactamase 1

316
Q

IL-8
Source:
Effect:

A

Source: Macrophages
Effect: Neutrophil chemotaxis

317
Q

Leprosy
What is the classification
How are they treated

A

Tuberculoid leprosy (immunocompetent) vs Lepromatous leprosy (immunosuppressed)

Tuberculoid leprosy (immunocompetent)
Monthly rifampicin &amp; daily dapsone for 6mths
Lepromatous leprosy (immunosuppressed)
Monthly rifampicin; daily dapsone &amp; clofazamine for 24mths
318
Q

what is the initial step in metabolism of isoniazid

A

acetylation

319
Q

Normal range for TSH

A

0.5 - 2.5

320
Q

Amiodarone induced thyrotoxicosis I
Pathology
Goitre present or not
Tx

A

Excess iodine induced thyroxine synthesis -> thyrotoxicosis
Goitre present
Tx: K percolate or carbimazole

321
Q

TNFa is released from what cell

What is its effect

A

Macrophages

Fever and neutrophil chemotaxis

322
Q

Bleomycin
Class
SE

A

Cytotoxic - Degrades preformed DNA - single DNA strand scission causing inhibition of cell division
(Blows over preformed DNA)
Lung fibrosis

323
Q

Association of HLA-DR2 (3)

A

narcolepsy
Goodpasture’s
SLE

324
Q

Methotrexate
MOA
SE

A

MOA: Antimetabolite; Inhibits dihydrofolate reductase and thymidylate synthesis
SE: Myelosuppression, mucositis, liver fibrosis, lung fibrosis

325
Q

Which cyclins and CDKs are active in S phase of cell cycle

A

Cyclin A and CDK 2

326
Q

Sleep terrors occur in which stage of sleep

A

Early stage 4

327
Q

After 3mths of statin use, what is the target for cholesterol

A

> 40% reduction in non-HDL cholesterol

328
Q

What drugs are levels informative in toxicity (8)

A 
Paraquat
Paracetamol
Salicylate 
Li
Iron 
Methanol
Ethylene glycol 
Theophylline
329
Q

SE of isoniazid

A

Peripheral neuropathy - taken with pyridoxine (B6)

Drug induced lupus

330
Q

What is Charles Bonnet syndrome

A

Visual hallucinations, known not to be real, in isolated elderly people, often with impaired vision.

331
Q

Ribavirin
MOA
SE

A

MOA:
Guanosine analog which inhibits inosine monophosphate (IMP) dehydrogenase -> interferes with the capping of viral mRNA

SE: haemolytic anaemia

332
Q

What is the tx for plaque psoriasis

1st, 2nd, 3rd

A

1 - Potent topical steroid with calcipotroil
Both applied daily for 4wks, one in the morning and one the evening

2 - BD topical vitamin D analogue if no improvement after 8wks

3 - a potent corticosteroid applied twice daily for up to 4 weeks or a coal tar preparation applied once or twice daily
short-acting dithranol can also be used

333
Q

What is the mode of action of terlipressin in hepatorenal syndrome

A

Smooth muscle relaxation -> decreased renin secretion

334
Q

Nivolumab

MOA

A

PD-1 inhibitor

335
Q

Cardiolipin tests for syphilis
Examples (2)
Stay positive or negative after tx’d infection

A

examples VDRL & RPR

becomes negative after treatment

336
Q

Cushings / Conns causes what kind of metabolic disturbance

A

Hypochloraemic metabolic alkalosis - low K, high Na

337
Q

Paraneoplastic syndromes - Anti-GAD antibody
Associations
CF

A

Associated with breast, colorectal and small cell lung carcinoma
CF: stiff person’s syndrome or diffuse hypertonia

338
Q

Porphyria cutanea Garda is due to a defect in which enzyme

What accumulates

A

Uroporphyrilinogen decarboxylase

339
Q

Inheritance of Retinoblastoma

A

AD

340
Q

What is the commonest form / source of partial seizure

A

Temporal lobe epilepsy

341
Q

Which spirometry measure is used to monitor the severity & progression of COPD

A

FEV1

FEV1/FVC <0.7 is for diagnosis only

342
Q

Inheritance of Fanconi anaemia

A

AR

343
Q

Drugs causing erythema nodosum

A

Hep B vaccine
Omeprazole
Isoretinoin

344
Q

t(8;21) is associated with which condition

What is likely to be present

A

AML

Auer rods

345
Q

Inheritance of AT-III deficiency

A

AD

346
Q

IL-5
Source:
Effect:

A

Source: Th2 cells
Effect: Stimulate production of eosinophils

347
Q

What is the side effect of GLP1 analogues

When are they CI

A

Delayed gastric empyting

CI if gastroparesis

348
Q

Inheritance of Nephrogenic diabetes insipidus

A

X-linked recessive

349
Q

Inheritance of Neurofibromatosis and chromosomes

A

AD
NF1 - chr 17 (neurofibromatosis has 1 letters)
NF2 - chr 22 (all the 2s)

350
Q

Raltegravir, elvitegravir, dolutegravir

MOA

A

Integrase inhibitors

351
Q

Confirmatory test for coeliac disease

A

Eat gluten for 6wks

Jejunal biopsy

352
Q

What are the acute SE of phenytoin (3-4)

A

Cerebellar sx - ataxia, slurred speech, dizziness
Diplopia
Nystagmus
+/- confusion & seizures

353
Q

What additional SE is present with sulfasalazine over mesalazine

A

Oligospermia

354
Q

What is the commonest cause of erythema multiforme

A

Herpes simplex

355
Q

How should AF with WPW be managed

A

Flecainide or DC cardioversion

356
Q

Didanosine
MOA
SE

A

Nucleoside RTI

SE: pancreatitis - didanosine makes you die of pancreatitis

357
Q

enfuvirtide

MOA

A

Attachment inhibitor - CCR5 antagonist

358
Q

What are the congenital causes of optic neuropathy

A

Friedrich’s
Mitochondrial disorders - Leber’s
Retinitis pigmentosa
Wolfram syndrome

359
Q

Features of a Holmes-Adie pupil

A

Dilated pupil
Slowly contracts to light and accommodation
Once constricted is very slow to dilate
Associated with decreased ankle reflexes

360
Q

HSMN type 2 gives what type of peripheral neuropathy

A

axonal

361
Q

Othello syndrome

A

Pt falsely holds wife / partner to be cheating on them, despite no evidence to support it

362
Q

What are the 5 patterns of psoriatic arthritis

A

Rheumatoid-like polyarthritis (commonest)
Oligoarthritis - hands and feet; asymmetrical
DIP joint disease
Sacroiliitis
Arthritis mutilans

363
Q

Causes of macroglossia (5)

A 
Duchenne muscular dystrophy
hypothyroidism
Acromegaly
Amyloidosis
Mucopolysaccharidosis (e.g. Hurler syndrome)
364
Q

Paraneoplastic syndromes - Anti-Yo
Associated with (2)
CF

A

Associated with ovarian and breast cancer

Cerebellar syndrome

365
Q

What proportion of primary syphilis cases progress to tertiary

A

30%

366
Q

Causes of a false positive syphilis cardiolipin test (5)

A 
pregnancy
SLE, anti-phospholipid syndrome
TB &amp; leprosy
malaria
HIV
367
Q

What does troponin C bind

A

Calcium

368
Q

What is the PPV of the faecal occult blood test for detecting colorectal cancer

A

5-15%

369
Q

TNFa is mainly secreted by

A

Macrophages

370
Q

What is the effect of C3 deficiency

A

Recurrent bacterial infections

371
Q

Cadasil
What is it
What are the features

A

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
Inherited stroke disorder due to notch 3 mutation on chr19
Presents with migraines, mood disorder & TIA/strokes

372
Q

Polyglandular autoimmune syndrome type 2
Also known as
Conditions within
HLA relation

A

Schmidt’s syndrome
HLA-DR3/4
Addison’s disease +/- T1DM or autoimmune thyroid disease

373
Q

What signs are associated with a cholesterol embolism

A

Eosinophilia
Livedo reticularis
Purpura
Renal failure

374
Q

Benserazide
MOA
Indication

A

Peripheral dopa-decarboxylase inhibitor

PD - reduces peripheral conversion of l-dopa to DA, reducing SE of postural hypotension and N&V

375
Q

What is seen on histology of rheumatic fever

A

Achaff bodies (granuloma with giant cells)

376
Q

How does alcohol cause a diuresis

A

Cranial DI - decreased release of ADH from the posterior pituitary

377
Q

Secondary causes of hyper-TGaemia (6)

A

DM (1 and 2) - high VLDL and low HDL
(Asian diabetics tend to have high TGs and low HDL)
Obesity
Alcohol
Chronic renal failure
Liver disease
Drugs: thiazides, beta-blockers, unopposed oestrogen, immunosuppressants

378
Q

What is the tx of VTE in cancer

A

LMWH for 6mths

379
Q 
Leukocyte alkaline phosphatase is:
High in (6)
Low in (4)
A 
Raised in
myelofibrosis
leukaemoid reactions
polycythaemia rubra vera
infections
steroids, Cushing's syndrome
pregnancy, oral contraceptive pill
Low in
chronic myeloid leukaemia
pernicious anaemia
paroxysmal nocturnal haemoglobinuria
infectious mononucleosis
380
Q

Which antibiotic class can lower the seizure threshold of epilepsy
Example
What is the mode of action

A

Quinolones
Ciprofloxacin
Inhibit DNA synthesis by interfering with DNA gyrase (topoisomerase II) and topoisomerase IV

381
Q

Inheritance of leech nyhan syndrome

A

x-linked recessive

382
Q

Which immunodeficiencies have defects in B & T cells

A

SCID Was Ataxic
SCID
Wiskott-Aldrich syndrome
Ataxia Telangiectasia

383
Q

IL-12
Source:
Effect:

A

Source: APCs - Dendritic cells, macrophages, B cells
Effect: Activates NK cells and stimulates differentiation of naive T cells (Th0) into Th1 cells

384
Q

Which SSRI is preferred for breast feeding

A

sertraline

385
Q

How can the SE of phenytoin be classified (4)

A

Acute
Chronic
Idiosyncratic
Teratogenic

386
Q

A prominent y descent in the JVP is seen in which condition

A

Constrictive pericarditis

387
Q

capecitabine is a pro-drug to which chemotherapeutic

A

5FU

388
Q

Gitelman vs Bartter syndrome
Which occurs as a child and which as an adult
Which causes stones

A

Bartter - child
Gitelman - adult
Both hypokalaemia met alkalosis
Bartters causes stones. Gitelman doesn’t

389
Q

How long should anticoagulation be continued after DC cardioversion of AF

A

4wks

390
Q

Association of HLA-DR3

A

dermatitis herpetiformis
Sjogren’s syndrome
primary biliary cirrhosis
Addisons

391
Q

Levothyroxine absorption is decreased by taking it with which drugs

A

Ca or Fe

392
Q

Inheritance of facioscapulohumeral muscular dystrophy

A

AD

393
Q

Superior ophthalmic vein and Inferior ophthalmic vein

Oculomotor nerve (III), Trochlear nerve (IV)
lacrimal, frontal and nasociliary branches of ophthalmic nerve (V1)
Abducent nerve (VI)

All leave via which foramen

A

Superior orbital fissure

394
Q

associated with ovarian and breast cancer

cerebellar syndrome

A

Anti-Yo

395
Q

Inheritance of Haemophilia A,B

A

X-linked recessive

396
Q

Commonest presentaiton of PsA

A

Asymmetrical seronegative oligoarthritis

397
Q

How do you calculate relative risk

What sort of study generates an RR

A

experimental event rate / control event rate

ER = number with thing happening / TOTAL number in that arm

Cohort - prospective

398
Q

Hashimotos thyroiditis increases the risk of what thyroid malignancy

A

Thyroid lymphoma

399
Q

What is the first line treatment for MRSA UTI

A

Doxycycline / tetracyclines

400
Q

Which immunodeficiencies have defects in B and T cells

A

SCID Was Ataxic
SCID
Wiskott-Aldrich syndrome
Ataxia Telangiectasia

401
Q

Gaucher’s disease
Defect
CF - 4

A

Glucocerebrosidase deficiency

Bruising &amp; thrombocytopaenia
Fatigue &amp; anaemia
Bone lesions / fractures
Immunocompromise
Hepatosplenomegaly
402
Q 
Chronic granulomatous disease	
Which cell type is affected
Defect
Effect
Tests
A

Neutrophil disorder
Lack of NADPH oxidase
Reduced ability of phagocytes to produce reactive oxygen species
Recurrent pneumonias and abscesses, particularly due to catalase-positive bacteria (e.g. Staphylococcus aureus and fungi (e.g. Aspergillus)
Negative nitroblue-tetrazolium test
Abnormal dihydrorhodamine flow cytometry test

403
Q

What drugs demonstrate zero-order kinetics (3)

A

Alcohol, phenytoin, salicylates

404
Q

What are the causes of a decreased TLCO

A 
Fibrosis
Pneumonia
Right to left shunting - pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output
405
Q

Chlorambucil
MOA
Indication

A

Cold autoimmune haemolytic anaemia

Alkylating agent

406
Q

Erythema gyratum repens is associated with which malignancy

A

Bronchial

407
Q

what drugs are metabolised by acetylation

A 
Drugs affected by acetylator status - “I Prefer Dynamic Hip Screws”
Isoniazid
Procainamide
Dapsone
Hydralazine
Sulfasalazine
408
Q

Inferior ophthalmic veins
Infraorbital artery
Infraorbital vein

Zygomatic nerve and infraorbital nerve of maxillary nerve (V2)
Orbital branches of pterygopalatine ganglion

Which skull foramen

A

Inferior orbital fissure

409
Q

Inheritance of Albinism

A

AR

410
Q

Which cytokines to Th1 cells secrete (3)

A

Involved in the cell mediated response and delayed (type IV) hypersensitivity
IL2, 3
IFNg

411
Q

Which cytokine triggers differentiation of Th0 cells to TH2 cells

A

IL5

412
Q

Cadasil
What is it
What are the features

A

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
Inherited stroke disorder due to notch 3 mutation on chr19
Presents with migraines, mood disorder and TIA/strokes

413
Q

IL-12
Source:
Effect:

A

Source: Dendritic cells, macrophages, B cells
Effect: Activates NK cells and stimulates differentiation of naive T cells into Th1 cells

414
Q

Cinacalcet
MOA
Indication

A

MOA: agonsit at the calcium sensing receptor of the parathyroid.

Indication:
Used with tertiary hyper-PTHism to reduced PTH secretion, where surgical parathyroidectomy may not be appropriate

415
Q

What is the driving restriction post first unprovoked/isolated seizure:

A

6 months - if no structural abnormalities on brain imaging & no definite epileptiform activity on EEG
Otherwise 12 months

416
Q

What is fourth line for c. diff infection after oral metro, oral vac, IV metro

A

Fidaxomycin

417
Q

What are the features of MEN2A

A

2Ps
Medullary thyroid cancer
Phaeochromocytoma
Parathyroid

418
Q

HSMN type 1 gives what type of peripheral neuropathy

A

demyelinating

419
Q

What electrophoresis pattern is seen in nephrotic syndrome

A

Low albumin

Raised a1 and a1 globulins

420
Q

IHD and AF - what is the anticoagulation guideline

A

If stable IHD -> oral anticoagulation only
If recent PCI / ACS -> 6mths of dual anti-plt tx with oral anticoagulation, then single antiplt oral anticoagulation until 12mths

421
Q

What are the SE of quinolone abx

A

Lower seizure threshold in patients with epilepsy
Tendon damage (including rupture) - the risk is increased in patients also taking steroids
Cartilage damage
Lengthens QT interval

422
Q

What abx can precipitate theophylline toxicity

A

Macrolides & quinolone

423
Q

Atazanavir
P450 inhibitor or inducer
MOA

A

Inhibitor

Protease inhibitor

424
Q

Association of HLA-B5

A

Behcet’s disease

425
Q

Association of HLA-B5

A

Behcet’s disease

Can cause both arterial and venous occlusion & venous vasculitis

426
Q

If all stages of plasmodium are visible in the blood, what is the likely species

A

O vale

427
Q

Which gastric diseases cause a lymphoma

Which cells are predominant

A

H. pylori - B-cell lymphoma

Coeliac - T-cell lymphoma

428
Q

SE of oxaliplatin

A

Sensory polyneuropathy

429
Q

Indications for IFN-a

A

Hep B&C
Metastatic renal malignancy
Kaposi sarcoma

430
Q

Inheritance of Androgen insensitivity syndrome

A

X-linked recessive

431
Q

What antibiotic causes creatinine to rise

Why

A

Trimethoprim
Competitively inhibits the tubular secretion of creatinine.
Rise reverses upon stopping the drug
Rise in creatinine does not represent a decrease in grr

432
Q

patients with suspected idiopathic intracranial htn - should a dx LP take place or OCP stopped first

A

LP

433
Q

For how long after a prosthetic valve replacement does staph epidermidis remain the most likely bug in IE, before staph aureus becomes more likely

A

2 months

Strep viridans becomes more likely long term

434
Q

What is the standard error of the mean

A

= sd / root (number of patients)

435
Q

Management (1st and 2nd line) tx of migraine in pregnancy

A

Migraine during pregnancy
paracetamol 1g is first-line
aspirin 300mg or ibuprofen 400mg can be used second-line in the first and second trimester

436
Q

Commonest cause of HCC in the Uk

A

hep C (hep B worldwide)

437
Q

Inheritance of Hereditary non-polyposis colorectal carcinoma (+genes -2)
Peutz-Jeghers syndrome
Inheritance of Familial adenomatous polyposis (+chr)

A

AD
HNPCC - MSH2 / MLH1
FAP - APC on chr 5

438
Q

What needs to be monitored with leflunomide therapy

A

BP - can cause hypertension

439
Q

Absorption of which drug is impaired by calcium carbonate or iron

A

Levothyroxine

440
Q

IL-12
Source:
Effect:

A

Source: APCs - Dendritic cells, macrophages, B cells
Effect: Activates NK cells and stimulates differentiation of naive T cells (Th0) into Th1 cells

441
Q

IL-5
Source:
Effect:

A

Source: Th2 cells
Effect: Stimulate production of eosinophils

442
Q

Causes of a LBBB (7)

A 
ischaemic heart disease
hypertension
aortic stenosis
cardiomyopathy
rare: idiopathic fibrosis, digoxin toxicity, hyperkalaemia
443
Q

Fluorouracil (5-FU)
MOA
SE

A

MOA: Antimetabolite; Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during S phase)
SE: Myelosuppression, mucositis, dermatitis

444
Q

What is common variable immunodeficiency (CVID)

A

Commonest clinically significant immunodeficiency
Defined as:
The presence of hypogammaglobulinaemia of two or more immunoglobulin isotypes (low IgG, IgA, or IgM)
Recurrent sinopulmonary infections
Impaired functional antibody responses

IgG is more likely to be deficient than IgM

445
Q

What are the features of a demyelinating polyneuropathy

What are the causes (5)

A

Demyelinating pathology - slowed conduction due to loss of myelin

Guillain-Barre syndrome
Chronic inflammatory demyelinating polyneuropathy (CIDP)
Amiodarone
Hereditary sensorimotor neuropathies (HSMN) type I
Paraprotein neuropathy

446
Q

Inheritance of Hypokalaemic periodic paralysis

A

AD

447
Q

On which chromosome are the alpha chains of Hb found (a-thal)

A

Chr 16

448
Q

Which spirometry measure is used to monitor the severity and progression of COPD

A

FEV1

FEV1/FVC <0.7 is for diagnosis only

449
Q

Inheritance of Von Hippel-Lindau syndrome

A

AD

450
Q

HLA Cw6 is associated with

A

psoriasis

451
Q

Associated with breast and small cell lung carcinoma

CF: ocular opsoclonus-myoclonus

A

Anti Ri

452
Q

What drug is used in myeloma when thalidomide is not tolerated

A

bortezomib

453
Q

What does troponin I bind

A

Actin

454
Q

Inheritance of Noonan syndrome

A

AD

455
Q

Steroids boost levels of which white cell

A

Neutrophils

456
Q

What is familial dis-b-lipoproteinaemia

How is it treated

A

ApeE2/2 genotype causing raised TGs

Tx’d with omega 3 acids or fibrates

457
Q

What are the thresholds for diagnosing DM in pregnancy

A

Fasting glucose >5.6

OGTT >7.8

458
Q

What are the SE of topiramate (3)

A

Weight loss, renal stones, cognitive and behavioural changes

459
Q

What is the tx of lichen planus

A

Topical steroids +/- oral steroids or immunosuppression if

extensive

460
Q 
Wilson's disease
Gene defect, chromosome &amp; inheritance
Effects
Serum caeruloplasmin is high/low
Serum copper is high/low
Urinary Cu excretion is high/low
A

AR inheritance of ATP7B gene on chr13
Cu deposition in basal ganglia, eyes and liver
Reduced serum caeruloplasmin
Reduced serum copper (counter-intuitive, but 95% of plasma copper is carried by ceruloplasmin)
Urinary copper excretion - Increased

461
Q

What is the preferred access for dialysis

A

AV fistula

462
Q

What are the idiosyncratic SE of phenytoin (7)

A

2 blood - Megaloblastic anaemia, aplastic anaemia
2 skin / systemic - fever, rash (TEN)
2 liver - Dupytren’s contracture, hepatitis
SLE

463
Q

Which cytokines to Th2 cells secrete (4)

A

involved in mediating humoral (antibody) immunity
e.g. stimulating production of IgE in asthma
secrete IL-4, IL-5, IL-6, IL-10, IL-13

464
Q

Which drugs can precipitate acute glaucoma

A

Amitriptyline and anticholinergics

465
Q

CCK
Released by which cells
Stimulus
Effect

A

I cells of upper small intestine

Partially digested proteins and TGs

Increases pancreatic secretions, GB contraction & relaxation of the sphincter of Oddi
Decreases gastric emptying
Trophic effect on pancreatic acinar cells
Induces satiety

466
Q

Which cytokine triggers differentiation of Th0 cells to TH1 cells

A

IL12

467
Q

Antibody associations of drug induced lupus

A

dsDNA -ve; anti ANA in 100%
Anti histone in 80-90%
anti-Ro, anti-Smith positive in around 5%

468
Q

Maraviroc

MOA

A

Attachment inhibitor - CCR5 antagonist

469
Q

t(11;14) - disease and mechanism

A 
Mantle cell lymphoma 
Cyclin D1 (BCL-1) deregulation
470
Q

Management of a secondary pneumothorax

A

If >50yrs & >2cm -> chest drain
1-2cm -> aspirate and if fails, chest drain
If <1cm -> oxygen only

471
Q

What are the treatments for pseudo gout

A

NSAIDs

Colchicine if NSAIDs contraindicated

472
Q

Optic nerve and Ophthalmic artery leave via which foramen

A

Optic canal

473
Q

ECG changes associated with hypokalaemia

A 
P wave flattening 
PR interval lengthening 
ST depression
T wave flattening or inversion
U waves
Long QT interval
474
Q

t(9;22) - disease and mechanism

A

Philadelphia chromosome - CML

475
Q

Ondansetron
MOA
SE

A

5HT3 antagonist
Acts at the chemoreceptorvtrigger zone of the medulla oblongata
Constipation is main side effect

476
Q

What are the chronic SE of phenytoin (7)

A

Peripheral neuropathy, gingival hyperplasia, coarsening of facial features, lymphadenopathy, hirsutism, osteomalacia, dyskinesia

477
Q

Inheritance of Romano-Ward syndrome

A

AD

478
Q

What does troponin T bind

A

Tropomyosin

479
Q

SLE is associated with deficiencies of which complement factors

A

C3 and 4

480
Q

What are the reversible complications of haemochromatosis

A

Cardiomyopathy

Skin pigmentation

481
Q

Benzbromarone
MOA
Indication

A

Benzbromarone
MOA: URAT-1 inhibitor - increases excretion of uric acid
Indications:
For those who fail to achieve sufficient uric acid target or who are still sx despite maximal allopurinol therapy

482
Q

What hormones are potentially secreted from a rental cell carcinoma

A

ACTH
Pth
Epo
Renin

483
Q

Tuberous sclerosis
What is it
What is the gene defect
What are the features

A

AD inherited neurocutanoues syndrome
TSC1 on chr9 - hamartin
TSC2 on chr16 - tuberin

Features:
Cutaneous - ash leaf macules; shagreen patch; adenoma sebaceum; subungual fibromas;
Neurological - epilepsy, developmental delay
Abdo - polycystic kidneys, angiomyolipomas
Retinal - hamartomas
Cardiac rhabdomyomas

484
Q

Churg Strauss is associated with which kind of GN

A

FSGS

485
Q

A 30-year-old female is diagnosed with having Grave’s disease. What is her chance of developing thyroid eye disease?

A

25-50%

486
Q

VIP
Released by which cells
Stimulus
Effect

A

Released by small intestine & pancreas

Stimulus: neural

Stimulates secretion by pancreas and intestines
Inhibits acid secretion

487
Q

Inheritance of FAP

Gene

A

AD defect in APC gene - chr 5

488
Q

Which drugs cause haemolysis in G6PDD (4)

A

Ciprofloxacin
Primaquire
Sulph-drugs - sulphonamides, sulphasalazine, sulfonylureas

489
Q

What are the causes of a raised TLCO

A 
Pulmonary haemorrhage 
Left to right shunts 
Hyperkinetic states
Asthma
Polycythaemia
male gender, exercise
490
Q

Which cytokines to Th1 cells secrete (3)

A

Involved in the cell mediated response and delayed (type IV) hypersensitivity
IL2, 3
IFNg

491
Q

What are the tx options for hiccoughs in palliative care

A

Chlorpromazine or haloperidol

492
Q

Associations of mesangiocapillary GN

A 
Mesangiocapillary glomerulonephritis (membranoproliferative)
type 1: cryoglobulinaemia, hepatitis C
type 2: partial lipodystrophy
493
Q

Terbinafine

MOA

A

Inhibits squalene oxidase

494
Q

Prognostic markers in ALL - good or bad?
Hypodiploidy
Hyperdiploidy
Trisomy 4, 10 and 17

t(12;21) translocation
t(1:19) translocation
t(9:22) translocation

Precursor B-ALL

A

Hypodiploidy - bad
Hyperdiploidy - good

Trisomy 4, 10 and 17 - good

t(12;21) translocation - good
t(1:19) translocation - good
t(9:22) translocation - bad

Precursor B-ALL - good; more responsive to chemotherapy

495
Q

Secondary causes of hypercholesterolaemia (3 - organs)

A

Hypercholesterolaemia:

Kidneys - Nephrotic syndrome, Chronic renal failure, dialysis or post-transplant
Liver - Cholestasis
Thyroid - Hypothyroidism

496
Q

Which drugs can worsen gout

A

Ciclosporin, alcohol, nicotinic acid, thiazides, loops, ethambutol, aspirin, pyrazinimade

497
Q

What are the 5 stages of lung changes in sarcoid

A 
Stage 0 - normal CXR
Stage 1 - BHL only
Stage 2 - BHL and pulmonary infiltrates 
Stage 3 - Diffuse pulmonary infiltrates only
Stage 4 - widespread fibrosis
498
Q

Febuxostat
MOA
Indication
CI

A

Xanthine oxidase inhibitor
Gout
CI with azathioprine - causes toxic accumulation

499
Q

What is added to standard RIPE therapy for tx of TB meningitis

A

Steroids

500
Q

t(9;22) - disease and mechanism

A

Philadelphia chromosome - CML

501
Q

Histology of IgA nephropathy

A

LM - Mesangial cell proliferation

IF - Granular IgA and C3 deposition in the mesangium

502
Q

Nevirapine
Delavirdine
Efavirenz

A

Non-nucleotide RTI

503
Q

Which TCAs are best and worst in OD

A

Best (least bad) - lofeprimine

Worst - amitryptiline or dosulepin

504
Q

What is the treatment for mall and syndrome

A

bHCG

505
Q

Hydroxyurea
MOA
SE

A

MOA: cytotoxic; Inhibits ribonucleotide reductase, decreasing DNA synthesis
SE: Myelosuppression

506
Q

Contraindication to lobectomy

A

FEV1 <1.5L

507
Q

Inheritance of Duchenne muscular dystrophy

A

X-linked recessive

508
Q

What are pts with Di George syndrome most at risk of

A

T-cell defect - viral and fungus infections

Eg cryptococcus

509
Q

What does the galactomannan test test for

A

ELISA - Invasive aspergillosis

510
Q

What are parameters of the CURB65 score

A 
Confusion
Urea >8
RR >30
BP <90 syst or <60 dias
Age >65
511
Q

What is the tx for bacillus anthracis infection

A

Ciprofloxacin or doxycycline

512
Q

Test of choice for giardia

A

Stool culture / antigen testing

513
Q

Causes of membranous GN

Classification (5)

A

idiopathic
infections: hepatitis B, malaria, syphilis
malignancy: lung cancer, lymphoma, leukaemia
drugs: gold, penicillamine, NSAIDs
autoimmune diseases: systemic lupus erythematosus (class V disease), thyroiditis, rheumatoid

514
Q

Association of HLA-DR4

A 
T1DM (associated with DR4>DR3)
rheumatoid arthritis
Pemphigus
Drug induced SLE
PMR
IgA nephropathy
515
Q

What is the role of IL-1

What is it secreted by

A

It is secreted mainly by macrophages and monocytes and acts as a costimulator of T cell and B cell proliferation.

Increases the expression of adhesion molecules on the endothelium.
Stimulates the release by the endothelium of vasoactive factors such as PAF, nitric oxide and prostacyclin
Causes vasodilation and increases vascular permeability.

516
Q

Which is painful, scleritis or episcleritis

A

Scleritis because it stings

517
Q

What tx is used for Tourette’s syndrome

A

Atypical antipyschotic eg risperidone

518
Q

TNFa is released from what cell

What is its effect

A

Macrophages

Fever and neutrophil chemotaxis

519
Q

MODY3 - 60%
What is the mutation
CF
tx

A

HNF-1a gene mutation
Higher glucose levels to be required to elicit insulin secretion.
Usually responsive to sulfonylureas - insulin not usually necessary

520
Q

Inheritance of Colour blindness

A

X-linked recessive

521
Q

Which antibody is most likely to be positive in dermatomyositis

A

ANA - commonest (positive in 60%)

25% are anti-Mi-2 positive - most specific

522
Q

Driving restrictions

Angioplasty (elective)

A

Angioplasty (elective) - 1 week off driving

523
Q

What is the driving restriction for someone experiencing multiple TIAs over a short time period

A

3mths

524
Q

c3 nephritic factor is what

A

Anti-C3bBb

525
Q 
Chediak-Higashi syndrome
Which cell type is affected
Defect
Effect
CF
A

Neutrophil disorder
Microtubule polymerization defect
Decrease in phagocytosis
Partial albinism, peripheral neuropathy, recurrent bacterial infections

526
Q

Which kind of melanoma is normally seen on the palms and soles

A

Acral lentiginous

527
Q

IL-4
Source:
Effect:

A

Source: Th2 cells
Effect: Stimulates proliferation and differentiation of B cells

528
Q

Driving restrictions

Successful catheter ablation for an arrhythmia

A

successful catheter ablation for an arrhythmia- 2 days off driving

529
Q

Paroxysmal nocturnal haemoglobinuria is associated with what cell markers
& what is the classic triad

A

CD55 & CD59 negative cells

Haemoglobinuria, pancytopenia & venous thrombosis

530
Q

Mucocutaneous leishmaniasis
Species
Tx

A

L. braziliensis

amphotericin B

531
Q

HLA DR1 is associated with what

A

Bronchiectasis

532
Q

Wernicke’s area
Where is it
What does it do
What effect does a stroke in this area have

A

Superior temporal gyrus - left temporal lobe
Responsible for recognising and analysing spoken language.
Causes a receptive dysphasia - poor repetition, poor comprehension

533
Q

Amiodarone induced thyrotoxicosis II
Pathology
Goitre present or not
Tx

A

Amiodarone related destruction of the thyroid
No goitre
Steroids

534
Q

What cytokine activates macrophages

What cell release it

A 
IFNg
Th1 cells (induced by IL12)
535
Q

pH 7.4 corresponds to what H+ conc

pH 7.0 corresponds to what H+ conc

A
  1. 4 = H+ of 40

7. 0 = H+ of 100

536
Q

Irradiated blood is given to prevent what

A

Graft vs host disease

537
Q

Mandibular nerve (V3)
Accessory meningeal artery
Which skull foramen

A

Foramen ovale

538
Q

Features of lateral medullary syndrome

A

Cerebellar features
ataxia
nystagmus

Brainstem features

ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss

539
Q

5 stages of diabetic glomerular nephropathy

A

Stage 1 - hyperfiltration: increase in GFR

Stage 2 (silent or latent phase) - pre-microalbuminuria

Stage 3 (incipient nephropathy) - microalbuminuria

Stage 4 (overt nephropathy) - persistent proteinuria

Stage 5 - end-stage renal disease

540
Q

Commonest SE of ticagrelor

A

Dyspnoea

541
Q

What is the best prognostic marker in multiple myeloma

A

B2 microglobulin

542
Q

Features of Alports syndrome

A

microscopic haematuria
progressive renal failure
bilateral sensorineural deafness
lenticonus: protrusion of the lens surface into the anterior chamber
retinitis pigmentosa
renal biopsy: splitting of lamina densa seen on electron microscopy

543
Q

Causes of a raised anion gap

A 
Raised anion gap
lactate: shock, hypoxia
ketones: diabetic ketoacidosis, alcohol
urate: renal failure
acid poisoning: salicylates, methanol
544
Q

chi-squared test

Parametric or non-parametric data

A

Non-parametric

Used to compare proportions or percentages

545
Q

Causes of a normal anion gap metabolic acidosis

A 
Normal anion gap ( = hyperchloraemic metabolic acidosis)
GRAD
GI bicarbonate loss: diarrhoea, fistula
Renal - renal tubular acidosis
Drugs: e.g. acetazolamide
Addison's disease
546
Q

At what level of falciparum parasitaemia should exchange transfusion be considered

A

10% parasitaemia on blood film

547
Q

What is the commonest malignancy associated with dermatomyositis

A

Lung

548
Q

What is the treatment for leptospirosis (Weil’s disease)

A

Penicillin or doxycycline

549
Q

What ophthalmic condition is most commonly associated with Charles Bonnet syndrome

A

AMD

550
Q

Which drug class is used first line to tx glaucoma in those with asthma

A

Prostaglandin analogue - latanoprost

551
Q

What are Gram negative cocci (2)

A

Neisseria & moroxella

552
Q

What is the MOA of mycophenylate

A

Inhibits inosine monophosphate dehydrogenase

553
Q

IL-6
Source:
Effect:

A

Source: Macrophages, Th2 cells
Effect:
Stimulates differentiation of B cells
Induces fever

554
Q

Foramen rotundum

A

Maxillary nerve (V2)

555
Q

What are the features of MEN2B

A 
1P
Phaeo
Medullary thyroid
Marfanoid 
Neurofibromatosis / neuromas
556
Q

4 features of tetralogy of fallot

A

Overriding aorta
Pulmonary atresia
Right ventricular hypertrophy
VSD

557
Q

What is the screening test for hereditary angiooedema

A

C4

558
Q

What is the most common ocular manifestation of RA

A

Keratoconjunctivitis sick - dryness of the eyes

559
Q

What factor is the strongest predictor of the risk of progression to cirrhosis in hep B

A

Viral load

560
Q

Drugs causing a raised ICP (7)

A 
Steroids
Tetracyclines
OCP
Isoretinoin
Levothyroxine
Lithium
Antihistamine - cimetidine
561
Q

Treponemal specific tests for syphilis
Examples (2)
Stay positive or negative after tx’d infection

A

THPA

Stay positive

562
Q

IL-3
Source:
Effect:

A

Source: Activated T helper cells
Effect: Stimulates differentiation and proliferation of myeloid progenitor cells

563
Q

What is the urinary test for phaeochromocytoma

A

24hr metnephrins

564
Q

Inheritance of Neurofibromatosis and chromosomes

A

AD
NF1 - chr 17 (neurofibromatosis has 1 letters)
NF2 - chr 22 (all the 2s)

565
Q

Drugs which can precipitate myasthenia crisis

A

Beta-blockers
Penicillamine, Quinidine, procainamide, Li, Phenytoin
Abx: aminoglycosides (gentamicin), macrolides, quinolones, tetracyclines

566
Q

What is the role of IL-1

What is it secreted by

A

It is secreted mainly by macrophages and monocytes and acts as a costimulator of T cell and B cell proliferation.

Increases the expression of adhesion molecules on the endothelium.
Stimulates the release by the endothelium of vasoactive factors such as PAF, nitric oxide and prostacyclin
Causes vasodilation and increases vascular permeability.

567
Q

MODY5
What is the mutation
CF
tx

A

HNF-1b gene mutation
Pancreatic atrophy & renal cysts
Usually responsive to sulfonylureas - insulin not usually necessary

568
Q

Which is more common - ostium primum or ostium secundrum ASD

A

Ostium secundum

569
Q

Commonest complication of ERCP

A

Acute pancreatitis

MRCP (3 decks)

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