MRCP Flashcards
1
Q
What are the features of a somatastatinoma?
A
- Cholelithiasis
- Diabetes
- Chronic diarrhoea
- Weight loss
- Steatorrhoea
2
Q
Ciclosporin facts
A
- Inhibits IL2
- Side effects: Gum hyperplasia and hypertrichosis, Hyperuricaemia, fluid retention
- Metabolised by CYP3A4 - interacts with macrolides and statins
3
Q
Klinefelter syndrome
A
- XXY
- Hypogonadism, elevated urinary gonadotrophin levels
- Need testosterone replacement therapu
4
Q
Chagas disease
A
- Trypanosoma Cruzi
- Fever, myalgia, hepatosplenomegaly, myocarditis
- Unilateral periorbital oedema (Romana’s sign)
5
Q
Anti malarial treatment
A
- Uncomplicated falciparum; Atovaquone proguanil,Artemisin combination
- Vivax - Choloroquine with primaquine (but high rates of chloroquine resistance in Asia)
6
Q
Rickettsia
A
- Rocky mountain spotted fever: Headache and fever, rash starts at peripheries and moves to the centre, spread by ticks
- Q fever (Coxiella burnetti); pneumonia
- Treated with tetracyclines (chloramphenicol in pregnancy)
7
Q
Acute GVHD
A
- Within 100 days of transplant
- Rash starts on palms and soles of feet
- Associated with diarrhoea
8
Q
HOCM
A
- Beta myosin heavy chains
- Autosomal dominant
- Disorganised fashion myocytes and myofibrillar hypertrophy
- Jerky pulse, large a waves
- ESM
- Poor prognostic features: young age at onset, family history of sudden cardiac death and syncopal sx. No correllation with LVOT gradient
9
Q
WPW
A
- ECG: short pR interval, delta waves
- LAD if right accessory pathway and vice versa
- Rx: radiofrequency ablation of accessory pathway, can use sotalol (not if in AF), amiodarone, felcainide,
10
Q
Lateral medullary syndrome (wallenbergs)
A
- PICA
- Ataxia and nystagmus
- Ipsilateral: dysphagia, facial nerve palsy, Horners
- Contralateral: limb sensory loss
11
Q
P450 INDUCERS
A
- St Johns wort
- Carbamazepine
- Rifampicin
- Alcohol
- Phenobarbitol
- GRiseofulvin
- Phenytoin
- SUlphonyl ureas
12
Q
P450 INHIBITORS
A
- Sodium valproate
- Isoniazid
- Cimetidine
- Ketoconazole
- Fluconazole
- Allopurinol
- Ciprofloxacin
- Erythomycin (macrolides)
- SSRI
- Chloramphenicol
- Omeprazole
- Metronidazole
- Grapefruit juice
13
Q
Stomach hormones
A
- Gastrin: Produced by G cells in antrum, stimulates parietal cells to release acid and mature, increases gastric motility
- CCK:I cells small intestine, increases release of pancreatic enzymes, decreases gastric emptying
- Secretin: S cells small intestine, increases release f bicarb rich fluid from hepatic and pancreatic duct c ells
- SOmatostatin: D cells in pancreas and stomach,decreases acid and pepsin secretion, decreases gastrin and pancreatic enzyme secretion, decreases insulin and glucagon secretion
14
Q
Lupus nephritis
A
1 - Minimal change 2 - Mesangial 3 - Focal segmental proliferative 4 - Diffuse proliferative 5 - Membranous 6 - Glomerusclerosis
- class 3, 4 and 5 treated with high dose steroid and either cyclophosphamide or mycophenolate mofetil
- Class 6 too advanced
- All treated with hydroxychloroquine
15
Q
Waldenstroms macroglobinaemia
A
- lymphoplasmacytoid malignancy, secretion of IgM paraprotein
- Weight loss and lethargy
- HYperviscosity syndrome
- Lymphadenopathy
16
Q
Upper zone lung fibrosis
A
- Coal miners lung
- Histocytosis
- Ank spond
- Radiation
- Tb
- Silicosis/sarcoidosis
17
Q
Lower Zone fibrosis
A
- Most connective tissue
- Asbestosis
- ILD
- Drug induced
18
Q
Adrenoreceptors
A
- Alpha 1:GI smooth muscle relaxation, vasoconstriction, hepatic glycogenolysis, salivary secretion
- Alpha 2: inhibits insulin, platelet aggregation
- Beta 1: heart contractility
- Beta 2 : Bronchial smooth muscle relaxation, vasodilation, GI smooth muscle relaxation
- Beta 3: lipolysis
- G protien coupled, Beta stimulate adenylate cyclase, a2 inhibits*
19
Q
Overdose
A
- Paracetamol: Charcoal if less than 1 hour, NAC
- Salicylate; urinary alkalisation with sodium bicarb, haemodialysis level more than 700
- TCA: sodium bicarb
- Lithium: mild to mod fluids, severe haemodialysis, can give sodium bicarb
- Lead: Dimercaprol, calcium edate
- Cyanide: hydroxocoalbumin
20
Q
Hypokalaemia +- Hypertension
A
- Conns: hypokalaemia + hypertension
- Liddle: hypokalaemia + hypertension, DCT issues causing reabsorption of sodium, autosomal dominant
- Gitelman: NCl transporter in DCT
- Bartters: NKCl transporter, autosomal recessive, ascending loop of henle
21
Q
Renal Tubular Acidosis
A
RTA 1: inability to generate acid urine, hypocalaemia, renal stones, associated with SLE, RA, sjogrens
RTA 2: decreased bicarb reabsorption, hypokalaemia, fanconi and wilsons, osteomalacia
RTA 3: rare, carbonic anhydrase ii deficiency
RTA 4: reduction in aldosterone leads to reduction in proximal tubular ammonia excretion, hyperkalaemia, DM and hypoaldosteronism
22
Q
Renal transplant
A
- Class 1 antigens ABC
- CLass 2 antigens D
- DR>B>A>C
- non hodgkins and skin cancer more common after transplantation due to immunosuppression
- CMV prophylaxis with valganciclovir
- CMV treatment with IV ganciclovir
- Tac inhibits T cell phosphatase
- SIrolimus inhibits T cell division
23
Q
Minimal change disease
A
- Nephrotic syndrome
- More common in children
- Steroid responsive
24
Q
Membranous glomerulonephritis
A
- Most common in adults with 2 peaks in 20s and 60s
- Nephrotic syndrome, proteinuria or CKD
- antiphospholipase A2 receptor
- IgG and complement deposition on gbm, spikes on silver stain
- Initial rx is with ACEI and ARB, may need immunosuppression
- Renal vein thrombosis in 5%
25
Q
FSGS
A
- Focal glomerular deposits of IgM seen
- Nephrotic syndrome
- Primary treated with steroids
- Secondary (due to HIV or heroin use) treated with immunosuppression
- 25% develop ESKD
- High level of recurrence in transplant patients
26
Q
Mesangiocapillary/membrano proliferative
A
- Type 1: Immune deposits in subendothelial space, associated with HCV and hep b
- Type 2: familial, dense depositis
- Type 3: hep b and c
- overall poor prognosis
- Steroids occasionally effective
27
Q
Diffuse proliferative GN
A
- Post streoptoccal (10-21 days after infection)
- Nephritic syndrome
- Post infectious cases resolve spontaneously
- Serum C3 levels low
28
Q
RPGN
A
- Associated with good pastures, anca positive vaculitis , and lupus nephritis
- Aggressive
- INitially managed with high dose steroids and pulsed cyclophosphamide therapy and plasma exhange if circulating antibodies
- Maintenance therapy is with low dose steroid and azathioprine or MMF
29
Q
Von hippel lindau
A
- Renal cysts premalignant and often prophylactic bilateral nephrectomy required
- AT risk of spinocerebellar haemangioblastomas
- Retinal angiomas, pancreatic cysts, islet cell tumours and phaeo
30
Q
Tuberous sclerosis
A
- Autosomal dominant
- Epilepsy and learning disability common
- Hamartomas, renal cysts, angiomyolipomas
- Shagreen patches, ash leaf spots and adenoma sebaceum
31
Q
Alport
A
- X linked dominant
- abnormal GBM
- Bilateral sensorineural deafness (may be mild)
- lenticonus
- Type IV collagen affected
32
Q
Acute interstitial nephritis
A
- AKI non oliguric
- 25% of drug induced AKI
- Systemic manifestations of hypersensitivity such as rash, raised IgE
- Biopsy shows oedema of interstitium and infiltration of plasma cells, lymphocytes and eosinophils
- Commonly caused by NSAID, penicillin and cephalosporin
33
Q
Renal calculi
A
- Staghorn: ‘struvite’, magnesium ammonium phosphate
- Urate and xanthine radiolucent
- Thiazides can be used to manage calcium based stones - Most common - mixed calcium oxalate and phosphate
34
Q
HUS
A
- Severe anaemia, AKI and thrombocytopoenia
- Associated with diarrhoeal illness caused by E Coli O157:H7
- Rx:transfusions, dialysis and plasma exchange
35
Q
TTP
A
- Severe anaemia, AKI and thrombocytopenia AND neurological abnormalities
- More indolent
- ADAMTS13 mutation associated with VWF build up which triggers platelet activation and intravascular thrombosis
- Rx: PLasmapharesis
36
Q
Fibromuscular dysplasia
A
- Young female develops AKI after being started on aCEI
- 10% of renal artery stenosis
- HTN, flash pulmonary oedema
37
Q
Normal anion gap acidosis
10-18
A
- GI loss
- RTA
- Acetozolamide
- Addisons
- Ammonium chloride injection
38
Q
Raised anion gap acidosis
>18
A
- Lactic acidosis (hypoxia, sepsis)
- DKA
- Renal failure
- salicylate or methanol overdose
39
Q
Data
A
- Normally distrubted: use mean and SD
- Not normally distributed: use median and IQR
- IQR: 3rd quartile - 1st quartile
40
Q
Stats
A
- Type 1 error: Reject the null hypothesis when it is correct
- Type 2 error: Accept the null hypothesis when it is incorrect
- Parametric tests: Student T test and Pearsons (correllation)
- Non Parametric:
Mann whitney - unpaired
CHi Squared: proportions or percentages
WIlcoxon - paired data
Spearmans - correllation
41
Q
Types of studies
A
- Cohort: Identify a specific cohort of patients and either follow them up prospectively or retrospectively
- Case control group: one group with specific outcome/exposure and one control, useful in disease with little info
- Cross sectional studies: Consider relationship between exposure and outcome at a single point
- Case reports open to publication bias
42
Q
Stats 2
A
- False negative = 1 - Sensitivity
- False positive = 1 - specificity
43
Q
Criteria for liver transplant
A
- Creatinine >300
- PT >100s
- Grade III or IV encephalopathy
- pH <7.3 24 hours post ingestion
44
Q
HLA types
A
- HLA DR1: bronchiectasis
- HLA DR2: SLE
- HLA DR3: Autoimmune hepatitis, primary sjogrens, SLE, Diabetes
- HLA DR4: Rheumatoid arthritis
- HLA B27: Seronegative arthritis
- HLA b51: Behcets
- HLA DQ2/DQ8: Coeliac
45
Q
Monoclonals
A
- Tociluzumab IL6 inhibitor - useful in GCA and PMR
Belimumab inhibits activation of B cell lymphocyte receptor used in SLE
OMalizumab neutralises circulating levels of IgE and is used in asthma
Mepolizumab IL5 inhibitor used in asthma with high eosinophils
Anakinra IL1 inhibitor used in adult onset stills disease
Ixekizumab targets IL-17 in psoriasis
46
Q
JVP waveform
A
- A atrial contraction
- C tricuspid closure
- X downward movement of the heart causes atrial stretch and drop in pressure
- V atrial filling against closed tricuspid valve
- Y - Opening of tricuspid valve
AF loss of a wave
Tricuspid regurg giant cV wave
Abscent y descent in cardiac tamponade
47
Q
Pulses
A
- Bisferiens: mixed aortic valve disease with signifcant regurg
- Jerky: HOCUM
- Alternans: Severe left ventricular dysfunction
- Pulsus paradoxus: tamponade, constrictive pericarditis, severe asthma
48
Q
Third and fourth heart sounds
A
- Third heart sound caused by rapid ventricular filling: VSD, mitral regurge, CCF
- Fourth heart sound: atrial contraction that fills a stiff left ventricle e.g. HOCM, LVH, amyloid
49
Q
First heart sounds (mitral and tricuspid valves)
A
- Loud: mobile mitral stenosis, hyperdynamic states, left to right shunt
- Quiet: immobile mitral stenosis, mitral regurgigation
- Split: LBBB, RBBB, VT, Ebstein’s anomaly
- Variable: AF, chb
50
Q
Second heart sound
A
- Loud: systemic and pulomonary HTN, ASD
- Soft or absent: severe AS
- Fixed split: ASD
- Widely split: RBBB, pulmonary stenosis, mitral regurg, inspiration
- Reverse split: LBBB, PDA, Aortic stenosis
- Single S2: Severe pulmonary/aortic stenosis, large VSD, tetralogy of fallot, Eisenmengers, pulmonary atresia
51
Q
Angina
A
- Decubitus: worse on lying down, associated with dreaming, cold sheets or coronary spasm during REM
- Prinzmetals: coronary vasospasm
- Syndrome x: ST depression n exercise testing but normal angiogram - very small vessel disease
52
Q
Chemotherapy drugs and side effects
A
- Cisplatin: side effect is AF
53
Q
Anti virals
A
- Aciclovir: DNA polymerase inhibitor
54
Q
Sarcoidosis
A
- Give pred for symptomatic hypercalcaemia and lung invovlement
- Asteroid bodies on biopsy of granuloma
55
Q
Syphilis
A
- TPHA test treponemal specific but remains positive after treatment
- VDRL non specfic cardiolipin test but becomes negative after treatment
56
Q
HIV
A
- Lentivirus
- HIV 1 common wordlwide, HIV 2 west africa
- Tropism for B lymphocytes, macrophages, T helper lymphocytes and CNS cells
- p24 antigen detectable at seroconversion
- For pcp, if pO2 less than 8 then give steroids
- CD4 less than 200 give co trim prophylaxis
- Cryptospordium: profuse watery diarrhoea
57
Q
NRTI
A
Zidovidune Lamivudine Tenofovir Abacavir Didanosine
58
Q
Facts
A
- Ribavirin causes haemolytic anaemia
59
Q
Resp facts
A
- Caplan syndrome; development of multiple pulmonary nodules in patients with seropositive rheumatoid arthritis
60
Q
Lichen planus
A
- Purple plaques with white lines on surface known as Wickham Striae
- Causes white lace like patten on buccal mucosa
61
Q
Bullous antibodies
A
- Pemphigus vulgaris: autoantibodies to desmoglein 1 and 3
- Bullous pemphigoid: BP180 and BP230
62
Q
The porphyrias
A
- Porphyria cutanea tarda: alcohol excess, photosensitive rash, decreased levels of uroprophinogen decarboxylase
- Acute intermittent prophyria: no skin signs
- Congenital erythropoeitic prophyria: brown teath which flouresce under wood’s light
63
Q
Haemochromatosis
A
Ferritin >500
%Sat transferrin >60
TIBC <20
Serum iron >30
