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MRCP Flashcards

1
Q

Conns (primary hyperaldosteronism)

Features

A

High BP
Low K*
Alkalosis

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2
Q

Conns
Investigation

A

Aldosterone/renin ratio
CT Adrenal

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3
Q

Melanoma of pales/soles/nails

African American

A

Acral Lentigous

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4
Q

Gilberts syndrome inheritence

A

Autosomal recessive

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5
Q

Cause of Gilberts Syndrome

A

Deficiency of USP glucuronyl transferase

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6
Q

Features of Gilberts Disease

A

Unconjugated billirubinaemia
Jaundice in illness
Rise in billirubin after prolonged fasting or IV nicotinic acid

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7
Q

Benzos MOA

A

GABA inhibitor
By increasing frequency of chloride channels

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8
Q

Dobutamine MOA

A

Beta 1 agonist

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9
Q

Salbutamol MOA

A

Beta 2 agonist

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10
Q

Ligand gate ion channels examples

A

Nicotinic acid
GABA

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11
Q

Tyrosine kinase receptor examples

A

Insulin
Epidermal growth factor
Prolactin EPO

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12
Q

Guanylate cyclase receptors examples

A

ANP
BNP

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13
Q

Polycystic kidney inheritance

A

Autosomal dominant
PKD1

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14
Q

PCP pneumonia features

A

Bilateral interstistial infiltrates
Exercise imduced desaturation
Needs broncheolar lavage
Often leads to pneumothorax

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15
Q

Mytonic dystrophy features

A

Distal weakness
Autosomal dominant
Diabetes
Dysarthria

DDDDDD

Cataracts
Ptosis

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16
Q

Renal transplant matching gene

A

HLA DR

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17
Q

Parvolex MOA

A

Replenishes glutathione which binds with paracetamol to make mercapturic acid
When that stops tries to use P450 so if on other inhibitors then lower threshold for parvolex

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18
Q

Rabies features

A

RNA rhabdovirus
Causes encephalitis
Negri bodies
Needs ABx and booster even if vaccinated

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19
Q

Anion Gap

A

(Na+K) - (Cl+HCO3)
Normal = 10-18

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20
Q

Raised anion gap causes

A

Lactate - shock/hypoxia
Ketones -DKA

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21
Q

Kaposis sarcoma virus

A

Human Herpes Virus 8

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22
Q

Osteomalacia electrolytes

A

Low vit D
High ALP
Low Ca2
Low phos

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23
Q

Serotonin syndrome tx

A

Serotonin antagonists eg cyproheptadine, chlorpromazine

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24
Q

MEN 1

A

3 Ps

Parathyroid
Pituitary tumours
Pancreas (insulinoma)
Common presentation = hypercalcaemia

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25
Q

MEN IIa

A

Medullary thyroid cancer
Parathyroid
Phaeocromocytoma

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26
Q

MEN IIb

A

Phaeochromocytoma
Marfanoid
Neuromas
Medullary thyroid cancer

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27
Q

Macrolides MOA, SE

(erythromycin, clarithromycin, azithromycin)

A

Inhibit protein synthesis
Prokinetic therefore GI SE
CHolestatic jaundice
P450 inhibitor

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28
Q

Alports syndrome features and inheritance

A

Inherited X linked
Type Iv collagen
Renal failure
Deafness
Renal transplant failure - anti GBM
Retinitis pigmentosa

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29
Q

Alpha 1 anti trypsin deficiency

A

Piss homo worse
Emphysema
Liver cirrohsis
TX IV alpha 1 anti trypsyn
Lung reduction surgery/transplant

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30
Q

Schistosomiasis tx

A

Praziquantel

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31
Q

CREST

A

Calcinosis
Raynauds
Esophageal dysmotility
Sclerodacttly
Telangectasia

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32
Q

Anti SCl 70

A

Diffuse systemic Sclerosis

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33
Q

Anti Ds DNA

A

SLE

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34
Q

Anti CCP

A

Rheumatoid arthritis

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35
Q

Anti mitochondrial AMA

A

PBC

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36
Q

Anti centromere

A

Limited cutaenous sclerosis

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37
Q

Penicillins MOA

A

Inhibit cell wall formation

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38
Q

Cephalosporins MOA (cefataxime)

A

Inhibit cell wall synthesis

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39
Q

Aminoglycosides (gentamicin, streptomycin)

A

Inhibit protein synthesis

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40
Q

Churg Strauss triad

A

Asthma
Mononeuritis
Esinophilia

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41
Q

Rituximab target

A

CD20

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42
Q

Complete heart block post MI location

A

RCA

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43
Q

Graves disease signs

A

Eye signs - exopthalmos, opthalmoplegia
Pretibial myoxedema
Thyroid acropathy

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44
Q

Most common lung ca in non smokers

A

Adenocarcinoma

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45
Q

Most common lung ca in smokers

A

Squamous cell

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46
Q

Most aggressive lung ca

A

Small cell

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47
Q

Whats does HBsAG positive mean?

A

Acute infection within 6 months or chronic if > 6 months

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48
Q

Anti HBs positive

A

Hep b immunity

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49
Q

Anti HBc positive

A

Infection at some point past or current

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50
Q

Lateral epicondylsis - painful movement

A

Wrist extension with flexed elbow

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51
Q

Type of renal disease ax with SLE

A

Diffuse proliferative glomuerulonephritis

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52
Q

Features of Steven Johnsons Syndrome

A

Mucosal involvement
Target lesions
Fever
Arthralgia
Vesicles/bullae

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53
Q

Drugs causing Steven Johnsons Syndrome

A

penicillin
sulphonamides
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill

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54
Q

Primary Hyperparathyroidism

A

High calcium
High/normal PTH
Low phos
From adenoma

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55
Q

JVP c wave

A

Closure of tricuspid wave

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56
Q

Aciclovir MOA

A

Inhibits DNA polymerase

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57
Q

Vitreous haemorrhage presentation

A

Dark shadows

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58
Q

Retinal detachment presentation

A

Painless loss of vision, dense shadow starts peripheral moving in

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59
Q

Wernickes encephalopathy features

A

Ataxia
Opthalmoplegia
Confusion

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60
Q

Korsakoffs features

A

Ataxia
Opthalmoplegia
Confusion
Amnesia
Confabulation

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61
Q

Amoebiasis features and treatment

A

Bloody diarrhoea
Hepatomegaly
Trophozoites
Tz metronidazole

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62
Q

Diabetes diagnostic critera

A

Fasting glucose 7 or more
Random/OGTT glucose 11.1 or more

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63
Q

Impaired fasting glucose

A

6.1-7.0

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64
Q

Impaired glucose tolerance

A

OGTT 7.8-11.1

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65
Q

Gullian barré infection + direction

A

Campylobacter
Ascending

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66
Q

Miller fischer syndrome

A

GB +
Othalmoplegia
Areflexia
Ataxia

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67
Q

HCOM Inheritance

A

Autosomal dominant

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68
Q

HCOM tissue change

A

B myosin heavy chain protein/myosinbinding c

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69
Q

Testicular seminoma marker

A

HCG

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70
Q

Silicosis CXR

A

Eggshell calcification upper zones

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71
Q

ABx causing prolonged QT

A

Erythromycin

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72
Q

Cyclophosphamide side effects

A

Haemorrhagic cystitis

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73
Q

cANCA

A

Wegeners

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74
Q

pANCA

A

Churg strauss

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75
Q

G6PD Deficiency features

A

Gallstones
Splenomegaly
Heinz bodies/blister cells
Neonatal jaundice

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76
Q

G6PD Deficiency triggers

A

Anti malarials eg quinines
Cipro
Flava beans
Sulphs

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77
Q

Coeliac disease HLA

A

HLA DQ2

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78
Q

Most common bacterial meningitis in adults

A

Strep pneumoniae
Neissera meningitidis

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79
Q

Most common meningitis in immunosuppresed

A

Listeria

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80
Q

Causative organism of granuloma inguinale

A

Klebsiella granulomatis

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81
Q

Sulfonylureas SEs (amides)

A

Hypos
Weight gain

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82
Q

Heparin MOA

A

Hinds to antithrombin III (so can’t make thrombin)

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83
Q

Thiazilidinediones (plioglitazone) MOA

A

PPAR gamma agonist - reduce insulin resistance

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84
Q

Hypothermia ECG changes

A

J waves

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85
Q

Gene neuroblastoma

A

N MYC

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86
Q

Klebsiella CXR

A

Upper lobe cavitating lesions

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87
Q

Coeliac ax renal disease

A

IgA Nephropathy

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88
Q

RTA 1

A

Cant excrete uric acid in distal tubule
Hypokalaemia
Nephrocalcinosis/kidney stones

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89
Q

Acromegaly tx

A

Ocreotide (somatostatin analogue, inhibits GH)

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90
Q

ICB with fluctuating conciousness

A

Subdural

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91
Q

Target INR Mechanical Mitral

A

3.5

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92
Q

Target INR Mechanical Aortic

A

3.0

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93
Q

Adenosine contraindicated in…

A

Asthmatics

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94
Q

VTE INR target

A

2.5

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95
Q

Recurrent VTE INR target

A

3.5

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96
Q

AF Target INR

A

2.5

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97
Q

Cluster headache tx

A

Sc sumatriptan and O2

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98
Q

Hyperosmolar Hyperglycaemic State - triad

A

1) really high BM >30
2) hyperosmolar
3) hypovolaemic

NO KETONES
NO ACIDOSIS

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99
Q

Background retinopathy features

A

Micro aneurysm
Blot haemorrhage
Hard exudates

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100
Q

Pre-proliferative retinopathy

A

cotton wool spots (soft exudates; ischaemic nerve fibres)
> 3 blot haemorrhages
venous beading/looping
deep/dark cluster

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101
Q

Listeria presentation

A

diarrhoea, flu-like illness
pneumonia , meningoencephalitis
ataxia and seizures

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102
Q

Simvastatin contraindicated in…

A

Pregnancy

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103
Q

Bleeding + anaemia + pulmonary AV malformations

A

Hereditary Haemorrhagic Telangectasia

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104
Q

Mechanism of increased thromboembolic risk in liver failure

A

Elevated Factor 8

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105
Q

Breast Ca Tumour Marker

A

Ca 15 3

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106
Q

Post flu pneumonia organism

A

Staph A

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107
Q

Post splenectomy on pen v - what organism susceptible to?

A

Hib

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108
Q

Prader-Willi Syndrome genetics

A

15q11/-13 microdeletion Paternal

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109
Q

Positive red Congo stain

A

Amyloidosis

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110
Q

Bendroflumethiazide MOA

A

inhibits sodium reabsorption by blocking the Na+-Cl− symporter at the beginning of the distal convoluted tubule

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111
Q

Narcolepsy MOA

A

Low orexin

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112
Q

High urea - pre-renal (AKI) vs Acute Tubular Necrosis

A

Pre renal = low urine sodium <20
AVN = high urine sodium >30

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113
Q

Reactive Arthritis Triad

A

Arthritis
+ conjunctivitis
+ urethritis

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114
Q

Pioglitazone main side effect

A

Peripheral edema
Weight gain
LFTs

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115
Q

Turners syndrome Cardiac defect

A

Bicuspid aortic valve

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116
Q

ABx causing MRSA

A

Cipro, penicillins

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117
Q

Rifampacin SE s

A

Orange bodily fluids, rash, hepatotoxicity, drug interactions

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118
Q

Isoniazid SEs

A

Peripheral neuropathy, psychosis, hepatotoxicity

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119
Q

Pyrizanimide SEs

A

Arthralgia, gout, hepatotoxicity, nausea

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120
Q

Ethambutol

A

Optic Neuritis. Rash

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121
Q

Ehler Danos Collagen type

A

Type 3 Collagen

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122
Q

Wiscott Aldrich Syndrome (4 features)

A

Eczema
Thrombocytopaenia
Recurrent chest infections
Low IgM

X linked recessive

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123
Q

Live Vaccines

A

BCG
MMR
Yellow Fever
Oral polio/typhoid

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124
Q

Radio opaque renal calculi

A

Calcium

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125
Q

Semi opaque renal calculi

A

Cistine

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126
Q

Radio lucent renal calculi

A

Xanthine
Urate

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127
Q

Lyme disease (buls eye/target rash) tx

A

PO doxy if not disseminated
IV cef if systemic

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128
Q

Joint aspiration Positively bifringent crystals

A

Pseudogout

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129
Q

calcium pyrophosphate dihydrate on joint aspiration

A

Pseudogout

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130
Q

Factors predisposing to pseudogout

A

Hypothyroid, HyperPTH, Low Mg, Low Phos, Wilsons, acro, haemochromatosis

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131
Q

Glycopeptide MOA (teicoplanin, vancomycin)

A

Inhibit cell wall synthesis

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132
Q

B12 Absorption

A

Active in terminal ileum

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133
Q

Causes of false +ve VLDR

A

SomeTimes Mistakes Happen
SLE, TB, Malaria, HIV

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134
Q

Urge Incontinence

A

Oxybutinin (cause inc risk falls/confusion), Darefenacin…
Mirabegron if hx of retention

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135
Q

Hypokalaemia and high BP

A

Vomiting, thiazides, Conns, Cushings

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136
Q

Non specific urethritis tx

A

Doxy/azythro

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137
Q

Most common site cardiac tumour

A

Left atrium

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138
Q

LTOT for COPD

A

x2 ABG with O2 <7.3

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139
Q

Multiple stomach ulcers, HyperPTH

A

MEN I (Zolllinger Ellinson)

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140
Q

CADASIL

A

young strokes
NOTCH3
Autosomal dominant

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141
Q

Anterior cerebral artery stroke

A

Contralateral hemiparesis and sensory loss, lower extremity > upper

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142
Q

Middle cerebral artery stroke

A

Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

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143
Q

Posterior cerebral artery stroke

A

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

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144
Q

Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain) stroke

A

Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

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145
Q

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)

A

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

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146
Q

Anterior inferior cerebellar artery (lateral pontine syndrome)

A

Symptoms are similar to Wallenberg’s (see above), but:
Ipsilateral: facial paralysis and deafness

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147
Q

Retinal/ophthalmic artery clot

A

Amaurosis fugax

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148
Q

Basilar artery

A

‘Locked-in’ syndrome

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149
Q

TTP Features

A

Fever
Bleeding
Haemolysis/renal failure
Neuro signs

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150
Q

Alpha Thalassaemia Chromosome number

A

16

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151
Q

Hereditary Spherocytosis

A

Autosomal dominant
failure to thrive
jaundice, gallstones
splenomegaly
aplastic crisis precipitated by parvovirus infection
MCHC elevated

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152
Q

Cause of Aplastic Crisis

A

Parovirus B19

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153
Q

Bromocriptine, ropinirole, cabergoline are examples of…

A

Dopamine agonists

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154
Q

Tear Drop Polikilocytes

A

Myelofibrosis

155
Q

Myelofibrosis presentation

A

eelderly person anaemia
massive splenomegaly
weight loss, night sweats etc

156
Q

Wilsons disease tx

A

Penicilliamine

157
Q

Wilsons disease genetics

A

ATP7B gene located on chromosome 13.

158
Q

Wilsons disease features

A

liver
neuro speech, behavioural psych
Kayser-Fleischer rings
renal tubular acidosis (esp. Fanconi syndrome)
haemolysis
blue nails

159
Q

Wilsons disease diagnosis

A

reduced serum caeruloplasmin
reduced serum copper
increased 24hr urinary copper excretion

160
Q

Syringomyelia

A

Loss of temp

161
Q

Mixed upper and lower motor neurone with fasciculations

162
Q

Drugs triggering Churg Strauss

A

LRA - montelukast

163
Q

Acute Migraine tx

A

Triptan and NSAID

164
Q

Migraine Prophylaxis

A

Propanolol, Topiramate (not for child bearing)

165
Q

ABx to avoid with methotrexate

A

Trimethoprim, Co-trimoxazol

166
Q

Which diabetic meds cause hypos

A

Sulfonylureas; glimperide, glicaclazide

167
Q

Bence Jones +ve with no boney lesions

A

Waldenstroms Macroglobulinaemia

168
Q

Rapid onset dementia + myoclonus

A

Creutzfeldt-Jakob disease

169
Q

Test for lead poisoning

A

urinary coproporphyrin

170
Q

First line Tx for Phaemochromocytoma

A

Phenoxybenzamine

171
Q

Courvosiers sign

A

Palpable gallbladder, painless jaundice - cholangiocarcinoma

172
Q

Myxoedemic coma tx

A

Hydrocortisone and thyroxine

173
Q

Cryptosporidium tx

A

nil - self limiting

174
Q

Blood film: bilobed large mononuclear cells

175
Q

Less severe alpha 1 anti trypsin allele

176
Q

More severe alpha 1 anti trypsin allele

177
Q

Cavitating lung ca

A

squamous cell

178
Q

diabetic meds causing severe pancreatitis

179
Q

renal transplant infection

180
Q

Alvardo Score

A

Acute Appendicitis

181
Q

Sjorgens syndrome HLA

182
Q

Indications for steroids in sarcoidosis

A

Lung disease
Hypercalcaemia
Neuro/cardiac involvement

183
Q

Factor V Leiden mechanisms

A

Activated protein C resistance

184
Q

Ca 15 3

185
Q

Alpha fetoprotein tumour marker

A

Testicular teratoma

186
Q

ABx PCP prophylaxis

A

Cotrimoxazole

187
Q

CD4 Count for PCP prophylaxis

188
Q

Haemophilia A clotting

A

Pt normal
APPT prolonged

189
Q

Haemophilia A factor

A

Factor VIII deficiency

190
Q

Chi squared test

A

To compare proportions/percentages

191
Q

Renal tubular acidosis ion gap

192
Q

Metabollic acidosis normal ion gap (hyperchloraemic acidosis) causes

A

GI losses
Renal tubular acidosis
Ammonia chloride
Addisons

193
Q

Metabollic acidosis raised ion gap

A

Lactic acid
Keto acid
Uric acid
Poisoning acid

194
Q

Sarcoidosis stage 1 CXR

195
Q

Sarcoidosis CXR
Stage 2

A

BHL + infiltrates

196
Q

Sarcoidosis CXR stage 3

A

Infiltrates

197
Q

Sarcoidosis stage 4 CXR

198
Q

Type of Hodgkins lymphoma with best prognosis

A

Lymphocyte predominant

199
Q

Type of Hodgkins lymphoma with worst prognosis

A

Lymphocyte depleted

200
Q

Most common type of hodgkins lymphoma

A

Nodular scelrosing

201
Q

Med for HER +ve breast ca

A

Trastuzumab

202
Q

Muddy brown casts

A

Acute tubular necrosis

203
Q

Charcot’s cholangitis triad

A

Fever + jaundice + RUQ pain

204
Q

Acute Myeloid Leukaemia
Good prognostic marker

A

Translocation 15:17

205
Q

MOA cetuximab

(Colorectal cancer)

A

Monoclonal antibody against epidermal growth factor

206
Q

What type of lung ca is Lambert Eaton Syndrome ax with?

207
Q

Waldenstroms Macroglobulinaemia

A

IgM Paraprotein
Weight loss
DVT

208
Q

Most aggresive melanoma

209
Q

Haeomolytic uraemic syndrome organism

210
Q

DIC blood film

A

Shistocytes

211
Q

Schistosomiasis bladder ca type

A

Squamous cell

212
Q

Nephrogenic diabetes mutations

213
Q

Pemphigous vulgaris

A

Desmoglein 3 mutation
Mucosal ulceration
Flaccid blisters - itchy but not painful
Acantholysis on biopsy
Nikolskys sign positive

214
Q

Drug induced thrombocytopaenia

A

Quinine
NSAIDS
Abx
Anti epileptics
Heparin

215
Q

Gastroenteritis few hours after eating bug

216
Q

Receptor for EBV

217
Q

What type of hypersensitivity reaction is ITP

218
Q

Cardiac abnormality ax with PKD

A

Mitral valve prolapse

219
Q

Hypo pigmentations + subungual fibromas

A

Tuberus sclerosis

220
Q

What do atypical lymphocytes suggest?

A

Glandular fever

221
Q

Cause of pellagra

A

Niacin B3 deficiency

222
Q

Pneumonia in bird keepers

A

Chlamydia psittaci

223
Q

Acute migraine rx

A

Triptan *NSAID/paracetamol

224
Q

Migraine prophylaxis

A

Tompirate
Propanolol

225
Q

Case control stats

A

Odds ratio

226
Q

Genital warts HPV

227
Q

Brown Sequard Mechanism

A

Lateral hemisection of spinal cord

228
Q

Tonsilitis organism

A

Strep pyogenes

229
Q

What does 3rd heart sound indicate

A

Constrictive pericarditis

230
Q

Bronchiectasis HLA

231
Q

SLE HLA

232
Q

Sjorgen HLA

233
Q

Autoimmune hepatitis HLA

234
Q

Cat scratch disease

A

Bartonella henselae

235
Q

Yellow fever presentation

A

Flu like illness
Then well period
Then jaundice + haematemesis

236
Q

Very high WCC leukaemia

A

Chronic myeloid leukaemia

237
Q

Hashimotoa thryroiditis

A

Hypothyroidism + goitre + anti TPO

238
Q

MODY gene

A

HNF 1 alpha

239
Q

Wood grain rash

A

Erythema gyratum repens

240
Q

Diabetic nephropathy histopathology

A

Nodular glomerulisclerosishyaline artiosclerosis
Kimmelstiel wilson lesions

241
Q

Hepatitis in pregnancy

242
Q

LVF pulse

A

Pulsus alternans

243
Q

Black bone spicule retina

A

Reinitis pigmentosa

244
Q

Retinitis pigmentosa features

A

Night blindness + tunnel vision

245
Q

Upper zone fibrosis

A

Extrinsic allergic alveolitis

246
Q

EAA causes

A

Bird fanciers
Farmers - saccharopolyspora rectivgula
Malt workers - aspergillous clavatus
Mushroom

247
Q

EAA bloods, broncheolar lavage

A

No eosinophilia on bloods
Lymphcytosis on lavage

248
Q

Non resolving pneumonia w dry cough

A

Cryptogenic organising pneumonia

249
Q

Abestosis - pleural plaques

A

Most common
Benign

250
Q

Asbestosis

A

Related to length of exposure
15-30 latent

251
Q

Abestosis fibrosis region

A

Lower zones

252
Q

Mesothelioma features

A

Progressive SOB
Chest pain
Pleural effusion

253
Q

SCLC Paraneoplastic features

A

ADH (hyponatraemia)
ATCH (high bm, htn, low k)
Lambert Eaton

254
Q

Lambert eaton - presentation and ax

A

SCLC
Myasthenia sx

255
Q

Squamous Cell Paraneoplastic features

A

Hyperparathyroidism
Hyperthyroid
Clubbing
Hypertrophic pulmonary osteoarthropathy

256
Q

Lung adenocarcinoma paraneoplastic features

A

HPOA
Gynaecomastia

257
Q

Causes of lung fibrosis CHARTS

A

Coal workers pneumoconiosis
Histiocyotisis/hypersensitivity pneumonitis
Ank spond
Radiation
Tb
Silicosis/sarcoid

258
Q

Drug causes of lung fibrosis

A

Amiodarone
Methotrexate
Bleomycin

259
Q

What cells does SCLC arise from

260
Q

When does pleural fluid need chest drain

A

pH <7.2
Purulent fluid
Positive culture

261
Q

Transudate vs exudate proteins

A

Exudates >30
Transudates <30

262
Q

When to use lights criteria for pleural fluid

A

Protein 25-30

263
Q

Lights criteria

A

Exudate =
Pleural fluid protein/serum protein >0.5
Pleural LDH/serum LDH >0.6
Pleural LDH more than 2/3 of upper limits normal serum LDH

264
Q

Where does mesothelioma metastases to

A

Other lung
Peritoneum

265
Q

Which lung is mesothelioma most commonly in

266
Q 
Pulmonary Hypertension (\>25mmhg)
Group 1
A

Idiopathic
Familial
Ax with sickle cell, HIV, congental heart disease w shunt, collagen disease

267
Q 
Pulmonary Hypertension (\>25mmhg)
Group 2
A

PHTN w left heart disease eg mitral valve or LVSD

268
Q 
Pulmonary Hypertension (\>25mmhg)
Group 3
A

Secondary to lung disease/hypoxia
Eg COPD, ILD, sleep apnoea, altitude

269
Q 
Pulmonary Hypertension (\>25mmhg)
Group 4
A

Due to thromboembolic disease

270
Q 
Pulmonary Hypertension (\>25mmhg)
Group 5
A

Miscellaneous eg sarcoid or carcinomatosis

271
Q

Primary pneumothorax <2cm and not SOB

272
Q

Primary pneumothorax >2cm/SOB

A

Aspirate
If fails chest drain

273
Q

Secondary pneumothorax <50 1-2cm

A

Aspirate
Admit 24 hr

274
Q

Secondary pneumothorax >50 >2cm/SOB

A

Chest drain

275
Q

Secondary pneumothorax <1cm

A

Admit 24 hours
O2

276
Q

Heart defect causing stroke/VTE

277
Q

Loud S2

A

HTN
Hyper dynamic
ASD w/o phtn

278
Q

Soft S2

279
Q

Fixed split S2

280
Q

Reversed split S2

A

LBBB
Severe AS
Righr ventricular pacing
WPW Tb
PDA

281
Q

Widely split S2

A

Deep inspiration
RBBB
Pulmonary stenosis
Severe MR

282
Q

WPW ECG changes

A

Short PR
Wide QRS with slurred upstroke
LAD/RAD

283
Q

WPW type 1 vs Type 2

A

Type 1 dominant r wave in v1

284
Q

Associated conditions of WPW

A

HOCM
Mitral valve prolapse
Ebsteins anomaly
Thyrotoxicosis
Secundum ASD

285
Q

WPW management

A

Ablation
Sotalol/amiodarone/flecanide

286
Q

Signs tricuspic regurg

A

Pan systolic murmur
Prominenet/ giant V waves JVP
Pulsatile hepatomegaly
Left parasternal heave

287
Q

Causes tricuspid regurg

A

RV infarct
PHTN
Rheumatic heart disease
IE
Ebateins anomaly
Carcinoid syndrome

288
Q

Poor prognostic factors Infective Endocarditis

A

Staph A
Prosthetic valve
Culture neg
Low complement

289
Q

Indications for surgery infection endocarditis

A

Severe valve incompetence
Aortic abcess
Resistant infection
Heart failure
Recurrent emboli

290
Q

Infective endocarditis - initial blind therapy

A

Amox and gent

291
Q

Infective endocarditis - initial blind therapy pen allergic

A

Vanc + gent

292
Q

Infective endocarditis - initial blind therapy prostethic valve

A

Vanc + gent + rifampicin

293
Q

Infective endocarditis - native valve staph

294
Q

Infective endocarditis - prostethic valve staph

A

Fluclox (or vanc if pen allergic) + gent + rifampicin

295
Q

Infective endocarditis caused by strep

A

Ben pen
+ gent if not fully sensitive

Switch benpen to vanc if pen allergic

296
Q

Features of severe AS

A

Narrow pulse pressure
Slow rising pulse
Soft/absent S2
Thrill
LVH
Fourth heart sound

297
Q

Causes of AS

A

Calcification
Bicuspid aortic valve
Williams syndrome
Post rheumatic disease
HOCM

298
Q

Management AS

A

If symptomatic or gradient >40 + LVSD replace
Balloon valvuloplasty if not fit for replacement

299
Q

Cannon waves JVP

A 
Regular = VT, AVRNT
Irregular = complete heart block
300
Q

Pulsus parodoxus

A

Severe asthma
Cardiac tamponade

301
Q

Slow rising pulse

302
Q

Collapsing pulse

A

Aortic regurg
PDA
hyperkinetic

303
Q

Pulsus alternans

A

Severe LVF

304
Q

Jerky pulse

305
Q

VT management

A

Drugs - amiodarone, lidocaine, procainamide, magnesium
Shock/ICD

306
Q

DVLA HTN

A

Fine unless unacceptable side effects
Group 2 not if 180/100

307
Q

DVLA angioplasty

308
Q

DVLA CANG

A

4 weeks off

309
Q

DVLA ACS

A

4 weeks off or 1 week if successful angio

310
Q

DVLA Angina

A

Cant drive if sx at rest

311
Q

DVLA pace maker inserted

A

1 week off

312
Q

DVLA ICD

A

Prophylactic 1 month, if not 6
Total ban for Group 2

313
Q

DVLA Catheter ablation

314
Q

DVLA
Aortic aneurysms

A

>6 notify DVLA
>6.5 cant drive

315
Q

Target BP <80

A

140/90 or ABPM/HPBM 135/85

316
Q

Target BP >80

A

150/90 or ABPM HBPM 145/85

317
Q

Coeliac HLA

A

HLA DQ2
HLA DQ8

318
Q

HLA DQ2/DQ8

319
Q

Coeliac complications

A

Anaemia
Hyposplenism
Osteoporosis/malacia
Lactose intolerance
Enteropathy ax t cell lymphoma
Subfertility

320
Q

Eczema herpticium features

A

Kinds who already have atopy
life threatening
HSV 1
acyclovir
puncted out lesions
monomorphic blisters

321
Q

Coeliac HLA

322
Q

Klebsiella pneumonia

A

Diabetics, alcoholics, aspiration
upper lobe

323
Q

DiGeorge syndrome

A

C - Cardiac abnormalities
A - Abnormal facies
T - Thymic aplasia
C - Cleft palate
H - Hypocalcaemia/ hypoparathyroidism
22 - Caused by chromosome 22 deletion

324
Q

erysipelas organism

A

strep pyogenes

325
Q

Peritonitis from dialysis organism

A

staph epidermis

326
Q

Hypothermia ecg

327
Q

Howell-Jolly bodies and pencil cells

A

coeliac
Post splenectomy

328
Q

extra dural haemorrhage vessel

329
Q

causes of prolonged qt

A

amiodarone, sotalol, class 1a antiarrhythmic drugs
TCA, SSRIs
methadone
chloroquine
terfenadine**
erythromycin
haloperidol
ondanestron

330
Q

stag horn calculi composition

331
Q

prosthetic valve endocarditis abx

A

rifampicin + vanc + gent

332
Q

Terlipressin - method of action

A

constriction of the splanchnic vessels

333
Q

anti jo 1 antibodies

A

polymyositis

334
Q

Lofgren’s syndrom

A

acute form sarcoidosis characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia.

335
Q

muscle cramp and brown urine after exercise

A

mcardle syndrome

336
Q

Lateral medullary syndrome

A

PICA lesion - cerebellar signs, contralateral sensory loss & ipsilateral Horner’s

337
Q

Complications of pancreatitis

A

Necrosis
Pseudocysts/fluid
Abcess Haemorrhage
ARDS

338
Q

Budd Chiari triad

A

Abdo pain
ascites
tender hepatosplenomegaly

339
Q

Causes of Budd Chiari

A

Polycythaemia rubra vera
Thrombophilia
OCP
Pregnancy

340
Q

Peutz Jegers

A

Pigmented lesions on palms, soles, mouth
Hamartous polyps
High risk of developing another cancer
Intusuception/obstruction/GI bleed

341
Q

Philadephia Chromsome

A

CML

(causes BCR ABL increased tyrosine kinase)

342
Q

CML Chromosome translocation

A

t9:22 q34:11

343
Q

t(15:17)

A

Acute Promyelotic leukaemia

344
Q

t(8:14)

A

Burkitts lymphoma
MYC oncogene

345
Q

t(11:14)

A

Mantle cell lymphoma

346
Q

t(14:18)

A

follicular lymphoma
BCL 2

347
Q

Leucocyte ALP raised conditions

A

Myelofibrosis
Leukaemia reactions
polycythaemia rubra vera
Infections
Cushings
Pregnancy/COCP

348
Q

Leucocyte ALP low conditions

A

CML
Pernicious anaemia
Paroxysmal nocturnal haemoglobuinuria
Infectious mononucleosis

349
Q

Features of lead poisoning

A

Abdo pain
Peripheral neuropathy
fatigue
constipation
blue lines on gum
Microcytic anaemia

350
Q

Hereditary Spherocytosis inhertiance

A

autosomal dominant
Northern European

351
Q

Hereditary Spherocytosis presentation

A

FTT
Jaundice/gallstones
Splenomegaly
Aplastic crisis w parvovirus
High MCHC
Spherocytes
EMA binding test

352
Q

G6PD Deficiency inheritance

A

Male ( X linked recessive)
African/mediterrean

353
Q

G6PD Deficiency mechanism

A

Low G6PD –> Low glutathione –> increased red cell susceptibility to ox stress

354
Q

Sickle cell thrombotics/vaso occlusive crises

A

painful
trigerred by infection/dehydration/hypoxia
infarcts in lots of organs

355
Q

Sickle cell Sequestration crises

A

Sickling within organs causing pooling of blood with worsening anaemia

356
Q

Sickle Cell Acute Chest syndrome

A

dyspnoea, chest apin, pulmonary infiltrates, low o2

357
Q

Sickle Cell Aplastic crises

A

Triggered by parvovirus
Sudden fall in haemoglbin

358
Q

Sickle Cell Haemolytic crises

A

Fall in Hb due to increased rate haemolysis

359
Q

Warm AIHA

A

+ve coombs
IgG
autoimmune/neoplasia/drugs methyldopa
central sites
responds well to steroids/splenectomy

360
Q

Cold AIHA

A

IgM
Raynauds/acrocyanosis
neoplasic eg lymphoma or infection eg mycoplasma/EBV

361
Q

Hereditary angioedema complement

A

Low C1-INH during attacks
Low c2 and C4 between attacks

362
Q

Hereditary angioedema symptoms

A

painful macular rash
paniless swelling subcut/submucosal tissues
not usually itching

363
Q

Hereditary angioedema management

A

C1 inhibitor concentrate
FFP
prophylactic steroids

364
Q

Polycythaemia vera features

A

hyperviscosity
Prurutis
Splenomegaly

365
Q

Polycythaemia vera management

A

aspirin
venesection
Hydroxyurea
Phosphorus 32

366
Q

Leukaemoid reaction features

A

High leucocyte ALP
Toxic granulation (dohle bodies)
Left shift of neutrophils

367
Q

Sickle Cell HbAA

368
Q

Sickle Cell HbAS

A

Trait, usually asymptomatic

369
Q

Sickle Cell HS SC/SB

A

Moderate disease

370
Q

Sickle Cell Hb SS/SBO

A

Severe disease

371
Q

Ann Arbor Hogdkins lymphoma

A

1 - single lymph node
2 - 2 lns same side diaphragm
3 lns both sides
4 distant spread to organs

A - no systemic sx except pruritic
B - weight loss, night sweats, fever

372
Q

How to diagnose CML

A

Immunophenotyping

373
Q

Smudge/smear cells

374
Q

Congenital Adrenal Hyperplasia - hormone deficieny

A

21 hydroxylase (or rarer 17)

375
Q

Cushings syndrome - ATCH dependant causes

A

pituitary secreting ATCH or SCLC secreting ATCH

376
Q

Features of metabollic syndrome

A

High waist circumference
High triglycerides
Reduced HDL
Raised BP
Raised fasting glucose

377
Q

Associated conditions of metabollic syndrome

A

PCOS
Raised uric acid
NAFLD

378
Q

What is MODY

A

T2DM in under 25 yr old

379
Q

MODY 3

A

60% of cases
defect in the HNF-1 alpha gene
increased risk of HCC

380
Q

MODY 2

A

20% of cases
defect in the glucokinase gene

381
Q

MODY 5

A

rare
defect in the HNF-1 beta gene
liver and renal cysts

382
Q

MODY Features

A

< 25 years
a family history of early onset diabetes
no ketosis presentation
very sensitive to sulfonylureas
insulin is not usually necessary

383
Q

Diabetes meds - GLP-1 meds eg

A

exanetide, liruglutide

384
Q

Diabeties meds DDP4 Inhibitors eg

MRCP (5 decks)

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