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MRCP all Flashcards

1
Q

What drug should be avoided in IBS?

A

Lactulose

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2
Q

What blood markers suggest Alcoholic liver disease OR non alcoholic liver disease?

A

ALD - AST: ALT >2

non alcoholic liver disease
ALT>AST

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3
Q

how is severe alcoholic hepatitis managed? what criteria is used for this ?

A

Corticosteroids

Maddreys discriminant function - uses PT and billirubin. if >32 then use steroids

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4
Q

what are the scoring systems for upper GI bleed?

A

Glasgow blatchford

Rockall - after endoscopy

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5
Q

what is the prophylaxis for reducing risk of variceal upper GI bleed?

A

Propanolol

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6
Q

What Ix is needed in Budd Chiari syndrome?

A

USS dopler of liver - very sensitive

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7
Q

What Abx prophylaxis is given in spontaneous bacterial peritonitis and when?

A 
Ciprofloxacin/ norfloxacin
if ascites + 
  - previous SBP
  - protein fluid <15g/l 
  - child pugh of 9
  - hepatorenal syndrome
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8
Q

how is spontaneous bacterial peritonitis diagnosed? what is the most common organism found?

A

neutrophils >250

Ecoli

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9
Q

what drugs cause cholestasis?

A 
COCP
steroids
fluclox 
erythromycin 
fibrates 
sulphonylureas
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10
Q

what change is seen in barrets oesophagus?

A

sqaumous –> columnar

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11
Q

when is barrets oesophagus treated?

A

metaplasia - endoscopic surviellence 3-5yrs

dysplasia - endoscopic mucosal resection/ radiofreq ablation

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12
Q

what is the target of clopidogrel?

A

P2Y ADP receptor

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13
Q

what drug makes clopidogrel less effective?

A

PPI

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14
Q

what does hypercalcaemia do to an ECG?

A

Short QT

also causes HTN

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15
Q

what are the causes of long QT?

A

hypo K, Mg, Ca, hypothermia

antidepressants (SSRI (citalopram), tricyclics),

antiarrhythmics (amiodarone, sotolol) ,

antibiotics - ciprofloxacin, erythromycin

other - SAH, myocarditis
Romeo ward
Jervall lange nielson

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16
Q

what are the ecg changes in hypo K

A 
no T/ flat
long PR 
long QT
ST depression
U waves
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17
Q

what is the treatment for mitral stenosis?

A

percutaneous mitral commissuratomy

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18
Q

What is the equation for sensitivity?

A

Out of the positive people how many of them test positive

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19
Q

What is the equation for positive predictive value?

A

OF all the positive tests, how many actually have the disease?

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20
Q

How are DNA, RNA and proteins investigated?

A

DNA - southern blot
RNA - northern blot
protein - western blot

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21
Q

Which Ab is most abdunant in the serum?

A

IgG

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22
Q

which Ab is most abdundant in breast milk and muscosal lining?

A

IgA

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23
Q

which Ab is first to respond to infection?

A

IgM

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24
Q

which antibody activates B cells?

A

IgD

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25
Q

which HLA is coeliacs, haemochromatosis and behcets? (each a separate one)

A

HLA DQ2 - coeliacs
HLA A3 - haemachromatosis
HLA b51 - behcets

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26
Q

which medication is first line for trigeminal neuralgia?

A

Carbemazepine

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27
Q

which Abx should be used for septic arthritis and how long?

A

IV fluclox
4-6 weeks
after 2 weeks can be made oral

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28
Q

which organism most commonly causes septic arthritis?

A

S.aureus

N.gonorrhoea - most common in young sexually active

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29
Q

how is septic arthritis most commonly acquired?

A

haematogenous spread

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30
Q

which is the most common site for septic arthritis?

A

knee

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31
Q

How are cluster headaches managed?

A

S/C sumatriptan + 100% O2

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32
Q

what are the triggers/ associateion of cluster headaches?

A

males
smokers
alcohol is a trigger

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33
Q

how can cluster headaches be prevented?

A

verapamil

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34
Q

how does radial tunnel syndrome present?

A

signs and symptoms like lateral epiconylitis however pain is about 4-5cm disatal to lateral epicondyl

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35
Q

what ECG change is seen in a subarachnoid haemorrhage?

A

ST elevation

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36
Q

what are the predictive factors for the outcome of SAH?

A

level of consciousness
age
amount of blood on CT

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37
Q

How does drug induced parkinsonism present differently to parkinsons?

A

motor symptoms rapid onset and bilateral
less rigidity and tremor in comparison

mask like face, flexed posture and restlessness - seen in both

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38
Q

what is the most common psych issue in parkinsons?

A

depression

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39
Q

Marfans is complicated by dural ectasia, how does this present?

A

ballooning or dural sac in lumbar level.

headaches, lower back pain, leg weakness, bladder/bowel changes

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40
Q

which Antibody is associated with dermatomyositis?

A

anti Mi2 - most specific

ANA - more common

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41
Q

Which malignancy is sjorgrens more at risk of?

A

lymphoid malignancy

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42
Q

which Ab are seen in sjogren, which is most common?

A

Ro> La

low C4

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43
Q

How is bells palsy managed?

A

oral pred within 72 hours of onset

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44
Q

which malignancy and antibody is stiff persons syndrome associated with?

A

anti GAD

colorectal, breast, small cell

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45
Q

how long does Driving need to be banned for after stroke/ TIA?

A

one TIA - one month

multiple TIA / stroke - 3 months + tell DVLA

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46
Q

what treatment best prolongs life expectancy in MND?

A

NIV > riluzole

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47
Q

what screening is needed on patients using hydroxychloroquine and why? what advice would you give pregnant women?

A

fundoscopy and visual tests before and annually.
Due to risk of bulls eye retinopathy
can be used in pregnancy

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48
Q

For bitemporal hemianopias how can we identify where a lesion is depending on the quadrant affected?

A

upper quadrants - pituitary

lower quadrants - craniopharygioma

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49
Q

which disease is HLA DR4 associated with?

A

diabetes

RA (DRB1 gene particularly)

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50
Q

Which Ab are associated with HLA DR2 ?

A

Nacrolepsy

goodpastures

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51
Q

What statistical test is used in cohort and case control studies?

A

cohort - relative risk

case control - odd ratio

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52
Q

For parametric data which tests can be used and when?

A

T test

pearson - correlation

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53
Q

for non parametric data which test can be used and when ?

A

man whitney - compares intervals/ ratios
wilcox - before and after
chi squared - compares % proportion
spearmans rank - correlation

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54
Q

list the translocations seen in haematological malignancy…

A

t(9:22) - CML , ALL (poor prog) - BCR ABL

t (14:18) - follicular lymphoma - BCL2

t(11:14 ) - mantle - cyclin D

T(8:14) - burkitts - myc

t(15:17) - promyelocytic - RAR-PML

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55
Q

what is the function of vWF?

A

stabilises factor VIII

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56
Q

what changes are there to clotting factors in von willebrand disease?

A

low factor 8

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57
Q

what is the treatment for von willebrand disease?

A

Desmopressin - stimulates release of vWF

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58
Q

what is the dose adrenaline for anaphylaxis by age?

A

<6 months: 100-150
6m-6yr 150microG
6-12yr: 300 microG
>12: 500microG

all 1 in 1000

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59
Q

what are the different cryoglobulinaemia immunoglobulins and what diseases are they associated with?

A

type 1 - monoclonal IgG or IgM. associated with muliple myeloma/ waldenstorm. only one with raynauds

type 2 - mixed mono/ polyclonal. hep C, RA, sjorgrens , lymphoma

type 3 - polyclonal. RA and sjogrens

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60
Q

what is the treatment for ITP?

A

oral prednisolone

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61
Q

what is evans syndrome?

A

ITP + autoimmune haemolytic anaemia

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62
Q 
state the mechanism and side effect of:
cyclophosmide
bleomycin
doxorubicin
vincistrine
A

cyclophosmadie - cross link DNA, haemorrhagic cystitis, transitional cell carcinoma, myelosupression

bleomycin - degrades DNA, lung fibrosis

doxorubicin - stabilises topoisomerase - cardiomyopathy

vincistrine - microtubule inhibition. peripheral neuropathy,, paralytic ileus

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63
Q 
state the mechanism and side effect of:
docetazxel 
irinotecan 
cisplatin 
hydroxyurea?
A

docetaxel - microtubule inhibitrion. neutropenia

irinotecan - topoisomerase inhibitor - myelosupression

cisplatin - cross links DNA. HypoMg, periperal neuropathy, ototoxic

hydroxyurea - inhibits ribonucleotide reductase

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64
Q

what is the best marker for diagnosis of hereditary angioedema between attacks?

A

low C4

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65
Q

what immunoglobulins are seen in cold and warm haemolytic anaemias?

A

cold - IgM

Warm - IgG

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66
Q

what infection gives burkitts?

A

MAlaria

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67
Q

which haematological malignancy is HIV linked to?

A

high grade B cell lymphoma

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68
Q

what is seen in methamoglobinaemia in terms of oxygenation?

A

low sats

normal pO2

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69
Q

what is the test for hereditary spherocytosis ?

A

EMA binding test

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70
Q

which drugs have 0 order kinetics?

A

salicyclates
ethanol
phenytoin
heparin

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71
Q

how does methanol poisoning present and how is it treated?

A

Like alcohol intox + visual changes

managed with fomepizole

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72
Q

what is the dose of adrenaline in adults in anaphylaxis vs cardiac arrest?

A

500micrograms - anaphylaxis (0.5 ml) (1 in 1000)
1mg in cardiac arrest (0.1ml) (1 in 10,000)
(or for cardiac arrest can use 1 in 1000, 1ml)

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73
Q

when can gastric levage and charcoal be used?

A

both within 1 hour of ingestion

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74
Q

what can be given for tricyclic OD And when?

A

IV bicarb if..

pH<7.1 , QRS >160 or arrhythmia

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75
Q

what are the side effects of sulphonylureas?

A

Hypoglycaemic episodes
Increased appetite and weight gain

Syndrome of inappropriate ADH secretion
Liver dysfunction (cholestatic)
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76
Q

what are the side effects of glitazones?

A

Weight gain
Fluid retention

Liver dysfunction
Fractures

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77
Q

What is the kings college criteria for liver transplant?

A

pH <7.3 ORRR…

Creatinine > 300
PT > 100 s
Hepatic encephalopathy 3 or 4

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78
Q

What is the mechanism of rifampicin , isoniazid and pyrazinamide?

A

Rifampicin - inhibits DNA dep RNA pol

Isoniazid - reduces mycolic synthesis

Pyrazinamide - inhibits fatty acids

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79
Q

What are the ADRs of rifampicin

A

Orange secretions
Hepatitis
Flu like symptoms
Liver enzyme inducer

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80
Q

What are the side effects of isoniazid ?

A

Peripheral neuropathy - give pyroxidine
Hepatitis
Agranulocytosis

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81
Q

What are the side effects of pyrazinamide?

A

Gout
Arhralgia, myalgia
Hepatitis

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82
Q

What is side effects of ethambutol

A

Optic neuritis

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83
Q

What drugs should not be taken with statins ?

A

Macrolides - erythromycin / clarithromycin

These inhibit p450 so statin levels rise to toxic

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84
Q

Which electrolyte can promote digoxin toxicity

A

HypoK

Because digoxin competes for pottasium binding site on Na/ K ATPase

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85
Q

What are the complications of transtuzumab?

A

Transtuzumab = herceptin
Cardiomyopathy
Do ECHO before starting
Don’t take with antracyclines e.g doxorubicin as these also cause cardiomyopathy

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86
Q

What are the side effects of dopamine agonists

A 
Fibrosis - pulmonary , retrroperitoneal
Sleepiness
Hallucination
Nausea
Postural hypotension
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87
Q

what organism is most commonly seen in animal bites and what is the management?

A

Pasteurella multicida

Mx:
co-amox
or doxy + metronidazole

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88
Q

what blood test suggests poor compliance to levothyroxine?

A

high TSH - has been trying to compensate for a while

normal T3/4 - has taken drug recently - short term fix before blood test

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89
Q

what are the ADRs of sulphonylureas?

A

weight gain
hypoglycaemia

SiADH
bone marrow sup
hepatotoxic
peripheral neuropathy

dont use in preg/ breast feeding

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90
Q

what inheritance is kallmans? what are the features?

A

X linked recessive

small testis, tall, anosmia

low / normal LH and FSH

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91
Q

what are the causes of euvolaemic hyponatraemia?

A

siADH
hypothyroid

urinary sodium high >20

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92
Q

which electrolyte is associated with low K?

A

low Mg

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93
Q

what inheritance does familial hyperlipidaemia have?

A

auto dominant

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94
Q

what are the complications of acromegaly?

A

HTN, CRC, diabetes, cardiomyopathy

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95
Q

what are the causes of gynaecomastia?

A

testicular failure - mumps
klinefelters , kallmans

seminoma - HCG secreting
haemodialysis
hyperthyroid

drugs = spironolactone, goreselin , digoxin, cimetidine, cannabis, finasteride, steroids

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96
Q

what is HbA1c 6% equivalent too?

A

42

1% = 11 increase

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97
Q

who are fibroids more common in?

A

afrocaribeans

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98
Q

what blood abnormality is seen with fibroids?

A

high Hb

fibroids produce EPO

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99
Q

What are the ADRs of SGLT2 inhibitors? what are thes drugs called?

A

Gliflozins

forniers gangrene
UTI
normoglycaemic ketoacidosis
limb amputation

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100
Q

what is the most common cause of primary hyperaldosteronism?

A

bilateral adrenal hyperplasia

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101
Q

what is the mechanism of action of thiazolinediones (TZDs) and the ADRs

A 
PPARg receptor (intracellular receptor) - increases insulin sensitivity
e.g. pioglitazone

ADRs - fluid retention - shouldnt be used in HF

  • weight gain
  • increased risk of fractures
  • increased risk of bladder Ca with pioglitazone
  • liver impairment - monitor LFTs

(fluid retention worse if also taking insulin)

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102
Q

How is SIADH initially managed?

A

fluid restriction

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103
Q

what is the management for diabetic nephropathy?

A

duloxetine, gabapentin, amitriptyline

tramadol for rescue therapy

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104
Q

how can you distinguish klinefelters and kallmans?

A

klinefelters - high LH/ FSH

Kallmans - normal/ low FSH / LH

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105
Q

Which genes are mutated in MODY

A

Type 3 - HNF1a - most common
Type 2 - glucokinase
Type 5- HNF1b - associated with cyst

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106
Q

Which type of malignancy does hashimotos predispose to ?

A

MALT lymphoma

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107
Q

What is the most common cause of Cushing’s syndrome

A

What is the most common cause of Cushing’s syndrome

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108
Q

How is gestational diabetes managed

A

If bm less than 7 can try diet and metformin but if targets are still not met with this then start insulin

If more than 7 - start insulin straight away
If any effects of diabetes e.g. macrosomia - start insulin

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109
Q

What is the first line for fertility in PCOS

A

Clomifene

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110
Q

Which antibodies are associated with Graves’ disease

A

Anti TSH r - stimulating -90%

Anti thyroid peroxidase - 70%

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111
Q

what is temporal arteritis assocaited with?

A

polymyalgia rheumatica

visual changes - anterior ischaemic optic neuropathy

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112
Q

what are the CK and EMG results in temporal arteritis? how is this condition managed?

A

normal results

high dose steroids

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113
Q

how is neuropathic pain managed?

what is max dose of amitriptyline

A

monotherapy
switch if not working

max dose amitriptyline = 75mg
try for 6-8 weeks or 2 weeks at max dose

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114
Q

what is miller fisher and what antibody is associated with this?

A

variant of guillian barre
Anti GQ1b
ataxia, areflexia and ophthalmoplegia
descending paralysis (reverse than normal)

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115
Q

who does polyarteritis nodosa affect? any other associations?

A

middle age men
Hep B
(not always ANCA positive)

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116
Q

what is the first line medication for stroke/ TIA?

A

clopidogrel

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117
Q

when is a carotid endartectomy performed?

A

when >70% stenosis

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118
Q

which part of lungs does ank spondylosis affect?

A

apical fibrosis

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119
Q

what is the prognosis of absence seizures?

A

excellent, 95% gone by adolescence.

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120
Q

which drugs make myasthenia gravis wose?

A 
B blockers
lithium 
gentamicin, tetracyclines, macrolides
phenytoin 
penicilliamine 
quinidine , procainamide
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121
Q

what are the classical signs of normal pressure hydrocephalus?

A

gait disturbances - magnetic/ parkinsonism
dementia
urinary incontinence

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122
Q

what is the management of general and focal seizures?

A

general inc myoclonic- sodium val

focal - carbemazepine

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123
Q

which seizures does carbemazepine make worse?

A

absence and myoclonic

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124
Q

how is an acute ischaemic stroke treated when within 4.5 hours?

A

thrombectomy - within 6
thrombolysis - within 4.5

if within 4.5hours can offer both of the above

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125
Q

how does CJD disease present?

A

rapid onset
dementia
rigidity
myoclonus

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126
Q

what improves prognosis for motor neuron disease?

A

riluzole - 2 to 3 years improvement

NIV - best outcome overall

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127
Q

which bacteria is most strongly associated with guillian barre?

A

campylobacter

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128
Q

what are the DVLA rules regarding seizures?

A

first seizure, unprovoked, normal EEG and imaging –> no driving 6 months and inform DVLA

otherwise 12 months seizure free

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129
Q

how is catheterised patients with positive urine dip treated?

A

not treated

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130
Q

what is the prophylaxis for meningitis in close contacts?

A

ciprofloxacin or rifampicin

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131
Q

what is webers syndrome?

A

stroke of branches of posterior cerebral artery that supplies the midbrain
ipsilateral CNIII
contralateral weakness of upper and lower limbs (internal capsule)

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132
Q

what is wallenberg syndrome? (aka lateral medullary)

A

posterior inferior cerebral artery
ipsilateral spinothalamic of the face
contralateral spinothalamic of the limbs
ataxia and nystagmus too

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133
Q

how is parkinsons managed depending on motor symtpoms?

A

motor symptoms affecting daily living - L dopa

not affecting daily living but having motor symptoms - ropinerole (dopamine agonist)

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134
Q

how is spasticity managed in MS?

A

gabapentin

baclofen

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135
Q

how are bladder issues in MS manaaged?

A

USS - if there is residual volume then intermitent self catheterisation.
if there is no residual vol then use an anti-cholinergic

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136
Q

How does tuberculoid leprosy differ from lepromatous leprosy?

A

Tuberculoid:

  • hair loss
  • assymetric nerve involvement
  • limited skin
  • high cell mediated immunity

lepromatous:

  • symmetrical nerve involvemnt
  • extensive skin involvment
  • low level cell immediated immunity
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137
Q

what skin and neuro changes are seen in leprosy?

A

hypopigmentation

sensory loss

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138
Q

what is the incubation period for amoebiasis like?

A

long period

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139
Q

what is the most common cause of viral meningitis?

A

enterovirus - coxsackie and echovirus

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140
Q

how does anthrax present cutaneously?

A

black painless eschar

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141
Q

how is anthrax treat?

A

ciprofloxacin or doxy

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142
Q

what is the most common complication of measles?

A

otitis media

pneumonia is most common cause of death

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143
Q

how does measles present?

A

rash starts behind ears
kolpik spots in mouth
conjunctivitis

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144
Q

what are the diagnostic features of bacterial vaginosis?

A

high pH (less lactobacilli)
clue cells
white thin fishy discharge
positive whiff test

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145
Q

how is bacterial vaginosis managed? and in pregnancy?

A

metronidazole

also in preg

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146
Q

what blood test finding is associated with glandular fever?

A

atypical lymphocytes

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147
Q

how is glandular fever diagnosed?

A

FBC and monospot test in 2nd week of illness

Monospot = heterophil Ab

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148
Q

how is pneumocytis jiroveci managed?

A

co-trimoxazole
steroids if hypoxic
IV pentamidine if severe

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149
Q

what is the most common organism of central line infections?

A

s. epidermidis

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150
Q

what do the following Abx target?

  • macrolides and cloramphenicol
  • aminoglycosides and tetracyclines?
A
  • macrolides and cloramphenicol - 50S ribosomes

- aminoglycosides and tetracyclines - 30S ribo

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151
Q

what time frame does tetanus vaccine need to be complete by for no further mx ?

A

if complete within 10 yrs no further doses or immunoglobulins regardless of wound type

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152
Q

what are the side effects of phenytoin?

A

gingival hyperplasia
lymphodenopathy
peripheral neuropathy
megaloblastic anaemia - secondary to folate deficiency

haemorrhagic disease of new born - bleeding mucus membrane, bleeding umbilicus and GI tract
teratogen

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153
Q

which spinal cord sections are affected in subacute degeneration of the cord?

A

dorsal columns

lateral corticospinal tracts - limb movement

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154
Q

what is the lateral and anterior corticospinal tracts responsible for?

A

lateral - limb movement

anterior - trunk movement

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155
Q

what is facioscapulohumeral muscular dystrophy?

A

auto dominant
face weakness, shoulder weakness,
presents by 20 yrs

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156
Q

what is multiple systems atrophy?

A

parkinsonism plus
autonomic issues - impotence, postural hypotension
cerebellar signs

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157
Q

how is serotonin syndrome and neuroleptic malignant syndrome differentiated?

A 
Only in serotonin:
myoclonus 
faster onset
increased reflexes 
dilated pupils

in NMS:

  • rigidity
  • reduced reflexes
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158
Q

what drugs cause gingival hyperplasia?

A

phenytoin
ciclosporin
calcium channel blockers
Acute myeloid leukaemia

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159
Q

for BPPV which manoevers are used to diagnose and treat?

A

dix halpike - diagnosis - vertigo and rotational nystagmus
epley - treatment
brandt- doroff exercises - at home exercises

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160
Q

which drug is used for SVT in asthmatics?

A

adenosine is contraindicated

use verapamil

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161
Q

how is future SVT prevented?

A

B blocker

radioablation

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162
Q

what heart sounds are heard in pulmonary HTN?

A

loud S2

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163
Q

which drugs are contraindicated in WPW?

A

adenosine and verapamil

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164
Q

what happens to the murmur in eisenmenger syndrome?

A

original murmur may disappear when shunt reverses

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165
Q

what are the features of takaysa arteritis?

A

asians
females
aorta and causes occlusion
typical Q refers to absent limb pulses

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166
Q

what is syndrome X? how is it managed?

A

presents like angina
but normal coronary arteries on angio
ST dep on exercise stress

nitrates to manage

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167
Q

what are the poor prognostic factors for HOCM?

A 
septal wall thickness >3cm 
non sustained VT
young age at presentation 
BP chnages with exercise
FHx of sudden death 
syncope
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168
Q

which drugs are preferred for BP control in afrocaribeans?

A

ARBs > ACEi

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169
Q

Which drugs during pregnancy are linked to ebstein anomoly?

A

lithium and benzos

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170
Q

how is severe eclampsia managed?

A

restrict fluids - risk of pulmonary/ cerebral oedema

IV MgSO4

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171
Q

how is aortic dissection managed?

A

type A - surgery + IV labetolol

type B - IV labetolol/ conservative

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172
Q

how is COPD managed (chronic)?

A

1st line - SABA/ SAMA
2nd line - check if asthma symptoms/ Hx of atopy/ eosinophilia/ variation in FEV1
- if yes - LABA + ICS (can later add LAMA if still no control)
- if no - LAMA + LABA

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173
Q

how does lichen planus present?

A

itchy rash, polygonal rash with white lines
on soles of feet/ palms, flexor surface, genitalia

white lace on oral mucosa

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174
Q

how is lichen planus managed?

A

potent topical steroids

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175
Q

how does DRESS syndrome present?

A 
multi organ - e.g. high LFTs
high eosinophils
morbilliform skin rash
fever 
following 2-8 weeks after offensive drug
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176
Q

what is TLCO and KCO?

A

TLCO - rate of diffusion across alveolar membrane

KCO - as above but corrected for lung volume

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177
Q

what are the causes of increased TLCO?

A 
pulmonary haemorrhage
polycythaemia
left to right shunt
asthma 
hyperkinetic state
exercise
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178
Q

how are bullous pemphigoid and phemigoid vulgaris differentiated?

A

bullous - no mucosal involvement

pemphigoid - mucosal invovlment

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179
Q

what antibody is found in pemiphoid vulgaris? who is it most common in?

A

anti desmoglein 3

Jews

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180
Q

which opioids are used in palliative patients with renal impairment?

A

oxycodone - mild renal failure

alfentanil - severe (or fentanyl / buprenorphine patch)

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181
Q

how are TRALI and TACO differentiated?

A

TRALI - hypotension, fever, increased leucopenia

TACO - hypertension, more common

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182
Q

which Ab are involved in acute haemolytic reaction after ABO mismatch?

A

IgM

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183
Q

what are the features of african sleeping sickness? which organism and vector

A

typanosoma gambiese
tstes fly
chancre, fever, posterior cervical nodes, sleepiness, headaches, mood change

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184
Q

what are the features of american trypanosomiasis/ chagas disease? which organism

A

typanosoma cruzi

acute - chagoma and periorbital oedema

cardiomyopathy - dilated cardiomegaly
megacolon/ oesophagus - constipation etc

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185
Q

how is american trypanosomiasis treated?

A

Benznidazole

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186
Q

how is african sleeping sickness treated?

A

IV pentamidine - early

IV metasoprol - later

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187
Q

what are the causes of aortic stenosis by age?

A

<65 - bicuspid valve

>65 - calcification

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188
Q

how is mural invasion best assessed with oesophageal/ gastric cancer?

A

endoscopic USS

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189
Q

what is the function of docetaxel?

A

microtubule inhibitor

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190
Q

what is the best predictor of COPD severity?

A

FEV1

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191
Q

most common symptom of P.E

A

tachypnoea

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192
Q

if an ECG still shows changes 90 mins after thrombolysis, what is the next stage?

A

if <50% resolution then PCI

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193
Q

where is BNP secreted from ?

A

left ventricle

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194
Q

what heart sounds are found in complete heart block?

A

variable S1

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195
Q

what is first line treatment for HF?

A

B B and ACEi in all patients - shown to improve mortality (only for those with reduced ejection fraction)
only bisoprolol or carvedilol have shown to improve mortality. no change for other BB

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196
Q

how is major bleed + a high INR managed?

A

5mg IV vit K

prothrombin complex concentrate

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197
Q

what are the features of hyperosmotic hyperglycaemic state?

A

osmolarity >320
glucose high
dehydration, low Na/low K
hypovolaemia

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198
Q

how do DKA and HHS compare?

A

HHS higher mortality
DKA - ketones
DKA - more acute
HHS - slow and insidious, worse electrolyte changes, more dehydrated

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199
Q

How is HHS managed?

A

fluid replacement

dont give insulin unless ketones are high

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200
Q

what are the different types of renal tubular acidosis?

A

T1 - inability to secrete H+, leads to hypokalaemia. associated with RA/SLE/ Sjogrens

T2 - inability to reab HCO3 at PCT , leads to hypoK
associated with fanconi and wilsons

T3 - rare carbonic anhydrase II deficiency.

T4 - hyperkalaemia, not enough aldosterone

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201
Q

how does a strongyloides infection present?

A

pruiritic rash on bum and soles of feet
abdo pain, bloating , diarrhoea

(worm penetrates skin)

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202
Q

how does progressive nuclear palsy present?

A

parkinsonism
vertical gaze impairment
postural instability and falls
cognitive impairment

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203
Q

how does progressive supranuclear palsy respond to levo dopa?

A

poor response

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204
Q

name the different diabetic drugs and give example.

A 
sulphonylurea - gliclazide
DDP4 inhibitors - gliptins
SGLT2 inhibitors - gliflozin
metformin
GLP 1 - exanatide 
TZDs - pioglitazone
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205
Q

what are the causes of nephrogenic diabetes insipidus?

A 
low K
high Ca 
lithium, demeclocycline 
sickle cell
pyelonephritis/ obstruction
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206
Q

what are the immune test findings in primary biliary cirrhosis? who is it most common in?

A

anti mitochondrial Ab
high IgM

middle aged women, sjogrens
also RA/ Systemic sclerosis, thyroid disease

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207
Q

how is primary biliary cirrhosis managed?

A

ursodeoxycholic acid

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208
Q

what is the mode of marfans inheritence and which gene is affected?

A

fibrillin 1

auto dom

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209
Q

how does altitude sicknes present?

A

tired, headache, sickness

can lead to pulmonary or cerebral oedema.

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210
Q

how is altitude sickness prevented? and treated?

A

prevented - acetazolamide (carbonic anhydrase inhibitor)
treated - descent.
cerebral oedema = dexamethasone

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211
Q

which anti depressant is most at risk of giving discontinuation syndrome?

A

paroxetine

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212
Q

what is peutz jeghers syndrome?

A

auto dominant
intestinal hamartomas polyps in GIT
frackles on lips, face, palms and soles

risk of intussusception, GI bleeding, cancer

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213
Q

how does wilsons disease present?

A

liver - hepatitis/ cirrhosis
neuro - basal ganglia - chorea, dementia, parkinsons
kayser fleischer rings
blue nails

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214
Q

what are the blood test findings in wilsons?

A

reduced serum caeroplasmin
reduced serum copper
increased 24 hour urinary copper

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215
Q

what is the management for wilsons?

A

penicillamine

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216
Q

which life style choice increases risk of thyroid eye disease?

A

smoking

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217
Q

which clotting factors are affected by warfarin?

A

1972 –> 10, 9, 7, 2

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218
Q

what happens in fanconi syndrome?

A

inadequate absorption in PCT

leads to renal tubular acidosis type 2

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219
Q

which is the most important HLA to match when giving a transplant?

A

HLA DR

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220
Q

how is QT measured?

A

start of Q

end of T

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221
Q

list the P450 inducers

A

phenytoin, carbemazepine
chronic alcohol
smoking
rifampicin

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222
Q

list the P450 inhibitors

A

cipro, erythromycin
acute alcohol
sodium valproate
isoniazid

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223
Q

how is complete heart block after an MI managed?

A

inferior MI - conservative management

anterior - temporary pacing

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224
Q

which drugs cause photosensitivity?

A 
thiazides
tetracyclines (doxy) 
amiodarone 
NSAIDs 
sulphonylureas
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225
Q

how is prinzmental angina managed?

A

Calcium channel blockers

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226
Q

what is bicalutamide?

A

androgen receptor antagonist

used in prostate Ca

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227
Q

which Chromosome is HLA found on?

A

6

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228
Q

how does Behcets present?

A

middle east

oral and genital ulcers, painful

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229
Q

how long should antidepressants be trialed before stopping?

A

6 months

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230
Q

how does plummer vinson syndrome present?

A

dysphagia, glossitis, iron def anaemia

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231
Q

what are the ADRs of ondansetron?

A

constipation

long QT

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232
Q

which drug reverses dabigatron?

A

idarucizumab

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233
Q

what are the poor prognostic features of RA?

A 
RF positive 
CCP posistive 
HLA DR4
early erosions on Xray
nodules
insideous onset 
poor functionality at the start
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234
Q

which vit D is used in CKD?

A

alfacalcidol and calcitriol

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235
Q

how is angina managed?

A 
aspirin, statin, GTN
B blocker e.g. atenolol 
\+ CaB - nifedipine 
increase to max dose
long acting nitrates (nicorandil, ivabradine, ranolazine)
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236
Q

how is orbital cellulitis managed (before anything)?why?

A

IV abx

risk of venous sinus thrombosis and intracranial spread

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237
Q

which type of blood transfusion carries highest risk of bacterial infection?

A

platelets

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238
Q

what is the chronic management of asthma?

A 
SABA
\+ ICS
\+ LRTA (montelukast)
\+ LABA  
switch to medium dose ICA 
switch to high dose/ extra drug
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239
Q

which is the most common renal stone?

A

calcium oxaloate

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240
Q

which are the radiolucent stones?

A

xanthine and uric acid

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241
Q

what is the most diagnostic Ix for CLL?

A

immunophenotyping

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242
Q

what is the most common cause of peritoneal dialysis infection?

A

s. epididermis

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243
Q

how is peritoneal dialysis infection managed?

A

vanc + ceftazidine - added to dialysis

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244
Q

how does NAC help in paracetamol OD?

A

precursor for glutathione

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245
Q

what is the kings college criteria for liver transplant post paracetamol OD?

A

pH <7.3
PT >100 s
Creat >300
hepatic enceph grade 3 or 4

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246
Q

what is the function of bisphosphonates?

A

inhibit osteoclasts

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247
Q

what is the mechanism of action of baclofen?

A

GABA agonist

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248
Q

how are pubic lice managed?

A

Permethrim or malathion cream

reapply 3-7 days later

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249
Q

what is a common side effect of oral Mg?

A

diarrhoea

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250
Q

what are the causes of erythema nodosum?

A 
pregnancy 
strept infection 
sarcoid 
IBD 
Behcet 
malignancy 
COCP/ penniclins
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251
Q

what drugs should be avoided in HOCM?

A

ACEi
nitrates
Ionotropes

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252
Q

which type of hepatitis is very severe in pregnancy?

A

E

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253
Q

what are the stages of diabetic nephropathy?

A
  1. hyperfiltration (high eGFR)
  2. latent
  3. incipient nephropathy - microalbuminaemia
  4. overt nephropathy - increase BP, increase protein, glomerulosclerosis
  5. End stage
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254
Q

what are the causes of nephrotic vs nephritic?

A

nephrotic - minimal change, focal segmental glomerulosclerosis, membranous and amyloidosis

nephritic - mesangial glomerulonephritis, rapidly progessive, IgA and alports

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255
Q

what are the symptoms of vit B3 deficiency?

A

niacin deficinecy

pellegra - dermatitis (rash on neck usually dark), dementia, diarrhoea

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256
Q

what is the most common complication of chagas disease?

A

dilated cardiomyopathy

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257
Q

how is urge incontinence managed?

A

bladder training- 6weeks
anticholinergics (oxybutynin, tolderidone)
- avoid in old women - risk of dementia
- instead mirabegron

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258
Q

how is stress incontinence managed?

A

pelvic floor training - 3 months
duloxetine
mid uretral tape

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259
Q

what does alcohol binging do to urination freq?

A

increased due to inhibition of ADH

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260
Q

what is cotard syndrome?

A

psych syndrome where person thinks they are dead

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261
Q

what is dermatitis artefacta?

A

self inflicted skin lesions

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262
Q

what are the causes of increased ferritin?

A

increased: CKD, Liver disease, alcohol excess, inflammation, malignancy

with iron overload - haemochromatsis or repeated transfusion

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263
Q

how is hospital acquired pneumonia managed?

A

Within 5 days of admission: co-amoxiclav or cefuroxime

More than 5 days after admission: tazocin

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264
Q

what is the treatment for actinic keratoses?

A

5 flurouracil cream - goes red and inflamed so can use steroid cream on top

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265
Q

what is the management and prophylaxis of a migraine? what is the mechnism of action of triptans.

A

acute: triptan + NSAID or triptan + paracetamol
prophylaxis: topiramate or propranolol

triptans are 5HT2 agonists

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266
Q

what is the action of mycophenolate mofetil

A

• inhibits inosine monophosphate dehydrogenase, which is needed for purine synthesis

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267
Q

which treatments reduce mortality in HF with a reduced ejection fraction?

A

ACEi
B blockers
spironolactone
nitrates and hydralazine

(not furosemide)

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268
Q

what are the stages of sarcoidosis on CXR? what other Ix findings are there?

A 
Sarcoidosis CXR
1 = BHL
2 = BHL + infiltrates
3 = infiltrates
4 = fibrosis

high ACE
high Ca
high ESR
non caseating granulomatosis

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269
Q

what are the examples of ADP receptor inhibitors?

A
  • Clopidogrel
    • Prasugrel
    • Ticagrelor
    • Ticlopidine
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270
Q

what is the main side effect of ticagrelor?

A

dyspnoea due to poor clearance of adenosine

should be used with caution in asthmatics

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271
Q

what is the treatment for methaglobinaemia?

A

NADH - methaemoglobinaemia reductase deficiency: ascorbic acid

IV methylthioninium chloride (methylene blue) if acquired

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272
Q

which thyroid cancer occurs in older woman, grows aggeessively and can cause pressure symptoms?

A

Anaplastic

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273
Q

which thyroid is most common in younger females?

A

papillary - good prognosis

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274
Q

what would give a false negative result in coeliacs?

A

IgA deficiency

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275
Q

what HbA1c value is diagnostic of diabetes?

A

6.5% (48mM)

prediabetes (6-6.5)

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276
Q

what factors can affect eGFR?

A

eating red meat 12 hrs before
exercise
pregnancy

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277
Q

what is akathsia?

A

severe restlessness

seen in patients taking antipsychotics

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278
Q

which are the poor prognostic factors of infective endocarditis ?

A

staphylococcus aureus - organism with highest mortality
culture negative
prosthetic valve
low complement levels

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279
Q

what is the management of infective endocarditis?

A 
Initial therapy if… 
	- Native valve:
		 Amoxicillin
	- Penicillin allergy/ MRSA
		Vancomycin + low dose gentamicin
	- Prosthetic valve
		 Vancomycin + low dose gent + rifampicin
Staphylococcal infection, if… 
	- Native valve
			§ Flucloxacillin
	- Pen allergy / MRSA:
			§ Vanco + rifampicin
	-  Prosthetic valve:
			§ Fluclox + rifampicin + low dose gent
Streptococci:
	- Native valve
			§ Benzylpenicillin
	-  MRSA/ pen allergy:
			§ Vancomycin + low dose gent
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280
Q

what are the indications for surgery in infective endocarditis?

A

severe valvular incompetence
aortic abscess (often indicated by a lengthening PR interval)
infections resistant to antibiotics/fungal infections
cardiac failure refractory to standard medical treatment
recurrent emboli after antibiotic therapy

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281
Q

what is the treatment for pityriasis versicolor

A

ketonazole shampoo

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282
Q

what is pityriasis versicolor?

A

fungal - Malassezia furfur

affects trunks/arms following sun tan

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283
Q

what drug reduces PSA? (and can cause a false negative result)?

A

Finasteride

284
Q

what factors increase PSA?

A 
vigorous exercise
ejaculation 
prostatitis/ UTI
instrumentation e.g. catheterisation
urinary retension 
BPH
285
Q

what investigations are used in acromegaly?

A

IGF1 levels
if raised - OGTT + serial GH levels

MRI pituitary

286
Q

what type of hypersensitivity does scabies cause?

A

type 4

287
Q

what are the features of horners syndrome?

A

miosis
anhydrosis
ptosis
enopthalmos

heterochromia (difference in eye colour) - seen in congential horners

288
Q

what is relapsing polychondritis?

A

inflammatory disease of cartilage.

signs and symptoms - auricular chondritis, nasal chondtritis, respiratory issues (wheeze, horseness etc), joint arthralgia.

manage with steroids/ DMARDs

289
Q

what is the discharge criteria for anaphylaxis?

A

Fast tract if..

  • Good response to one adrenaline dose
  • Complete resolution of symptoms
  • Has been given autoinjector and trained how to use it

Minimum 6 hours after symptoms resolution
○ 2 doses of IM adrenaline
○ Previous biphasic reaction

Minimum 12 hours after symptoms resolved
○ Severe reaction >2 injections needed
○ Has severe asthma
○ Late at night presentation
○ Difficult access to ED
○ Possibility of ongoing reaction - e.g. slow release allergen medication

290
Q

what are the two types of polycystic kidney disease and how do they differ?

A

PKD1 - earlier renal failure, more common. PKD1 on chrom 16

PKD2 on chrom 4

291
Q

what is the management of polycystic kidney disease?

A

ADH receptor ANTAGONIST
- Tolvaptan

slows progression of cyst

292
Q

what is the diagnosis for li fraumeni syndrome? what is the genetics behind this syndrome?

A

sarcoma under age or 45yrs
OR

relative with sarcoma <45yrs AND 1st degree with any cancer <45yrs

li fraumeni = auto dom and p53 mutation

293
Q

what is the main indication for cryoprecipitate use?

A

low fibrinogen

294
Q

what part of lung does amiodarone affect?

A

lower zone fibrosis

295
Q

what causes lung fibrosis in upper zones?

A 
CHARTS
C - Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
296
Q

what causes lung fibrosis in lower zones?

A

idiopathic pulmonary fibrosis
most connective tissue disorders (except ankylosing spondylitis)
drug-induced: amiodarone, bleomycin, methotrexate
asbestosis

297
Q

what triad is seen in haemolytic uraemic syndrome?

A

AKI

micro-angiopathic haemolytic anaemia

thrombocytopenia

298
Q

what is the cause of haemolytic uraemic syndrome?

A

Shiga toxin producing Ecoli

pneumococcal
HIV
drugs
cancer

299
Q

who is sarcoidosis more common in?

A

Africans

300
Q

what are the poor prognostic features of sarcoidosis?

A

insidious onset >6 m

absence of erythema nodosum

extrapulmonary manifestations - lupus/ splenomegaly

CXR III or IV

black people

301
Q

how is retinitis pigmentosa characterised?

A

Retinitis pigmentosa - night blindness + tunnel vision

302
Q

what symptoms are common in posterior vitreous detachment?

A

flashes and floaters

303
Q

what is conversion disorder?

A

Conversion disorder - typically involves loss of motor or sensory function. May be caused by stress

304
Q

what antibodies are seen in bullous pemphigoid

A

antibodies against hemidesmosomal proteins BP180 and BP230.

305
Q

how does retinal detachment present?

A

painless visual loss
sudden
dense dark shadow from peripheral to centre

306
Q

how does optic neuritis present?

A

loss of vision - often transient

painful eye movmeents

307
Q

what are the features of asperigilloma?

A

rounded opacification with a cresent sign air cavity

more common in people with TB

308
Q

what is the most common cause of hyperparathyroidism?

A

parathyroid adenoma - 80%
hyperplasia
mutliple adenoma
carcinoma

PTH doesnt have to be high in parathyroid adenoma but can be inappropriately normal (i.e. should be low if Ca is high)

309
Q

what happens to INR target if patient has has a thrombosis on warfarin ?

A

increase INR target e.g. 2-3 to 3-4 and make warfarin life long

310
Q

if pain not controlled in palliative patients, how much should morphine be increased by?

A

30-50%

311
Q

How are Dermatophyte nail infections treated? e.g. Trichophyton rubrum

A
  • use oral terbinafine 12 weeks
312
Q

what prophylaxis is given to meningococcal contacts?

A

ciprofloxacin within 7 days

only for meningococcal disease. no need for pneumococcal

313
Q

what are the risk factors for statin induced myopathy?

A

advanced age
female sex
low body mass index

presence of multisystem disease such as diabetes mellitus.

Myopathy is more common in lipophilic statins (simvastatin, atorvastatin) than relatively hydrophilic statins (rosuvastatin, pravastatin, fluvastatin)

314
Q

what is seen on JVP in tricuspid regurg?

A

prominant V waves

315
Q 
when are the following seen?... 
cannon A waves 
absent A waves
prominent X descent
absent X descent
A

irregular Cannon A waves = complete heart block

Absent A waves = atrial fibrillation

Prominent x descent is = acute cardiac tamponade and constrictive pericarditis

Absent x descent = atrial fibrillation

316
Q

which drug are patients with MODY nromally given?

A

dont usualy require insulin

normally given sulphonylureas

317
Q

which drugs enhance/ reduce the effects of adenosine?

A

Adenosine
dipyridamole enhances effect
aminophylline reduces effect

318
Q

what drugs are used in alcohol withdrawel?

A

chlordiazepoxide or diazepam.

Lorazepam may be preferable in patients with hepatic failure.

319
Q

what are the features of severe aortic stenosis?

A

narrow pulse pressure
slow rising pulse

delayed ESM
soft/absent S2
S4

thrill
duration of murmur
left ventricular hypertrophy or failure

320
Q

what are the topical steroids strengths order?

A

Topical steroids
mild - hydrocortisone
moderate: Clobetasone butyrate 0.05% (Eumovate)
potent: Betamethasone valerate 0.1% (betnovate)
very potent: Clobetasol propionate 0.05% (Dermovate)

321
Q

What are the different medications that can be used in smoking cessation and their mechnaism?

A

nicotine replacemnt
varenicline - nicotine partial agonist
Bupropion - NA and dopamine reuptake inhibitor and nicotinic antagonist

322
Q

what is sick euthyroid?

A

during illness T3/4 go low, TSH is normal or low

reversible

323
Q

how is IgA nephropathy and post streptococcal syndrome differentiated ?

A

post-streptococcal glomerulonephritis

  • associated with low complement levels
  • occurs 2 weeks after infection
  • mainly proteinuria (although haematuria can occur)

IgA nephropathy

  • haematuria
  • 2 days post infection
324
Q

which cancers are seen in MEN type 1, 2a and 2b?

A

1a = 3 Ps

  • parathyroid (95%)
  • pituitary
  • pancreas

IIa = 2ps

  • parathyroid (60%)
  • pheochromocytoma
  • mainly medullary thyroid (70%)

IIb = 1p

  • pheochromocytoma
  • mainly medullary thyroid cancer
  • marfanoid
  • neuromas
325
Q

which genes are mutated in MEN 1/2a/b?

A

men type 1 = MEN 1

Men 2a - RET oncogene
Men 2b - RET oncogene

326
Q

what are the features of polycystic kidney disease?

A

HTN, haematuria, UTI , renal stones, abdo pain, CKD

extra renal:
liver cysts
berry aneurysm
cardiac - mitral valve prolapse, aortic root dilation, aoritc dissection, mitral/tricuspid incompetence

327
Q

how is non-falciparium malaria managed?

A

artemisinin-based combination therapy (ACT) or chloroquine
in areas which are known to be chloroquine-resistant an ACT should be used

ACTs should be avoided in pregnant women

patients with ovale or vivax malaria should be given primaquine following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse

328
Q

how does non-falciparium malaria present?

A

headache
hepatosplenomegaly
cyclical fever - vivax and ovale every 48hrs, malarie every 72 hours.
malarie also associated with nephrotic syndrome

329
Q

what is the commonest form of malaria

A

falciparium - and most severe

330
Q

what are the features of severe falciparium infection?

A 
Feature of severe malaria
	• schizonts on a blood film
	• parasitaemia > 2%
	• hypoglycaemia
	• acidosis
	• temperature > 39 °C
	• severe anaemia
	• complications
331
Q

how is falciparium managed?

A

Artemisinin-based combination therapies (ACTs) as first-line therapy
examples include artemether plus lumefantrine

if severe - IV artusunate
if parasite count 10% or more - exchange transfusion

332
Q

how is minimal change glomerulonephritis managed?

A

oral prednisolone

333
Q

where are iron and calcium absorbed?

A

duodenum

334
Q

what are the features of ataxia telangiectasia? which mode of inheritance

A

cerebellar ataxia
telangiectasia (spider angiomas)
IgA deficiency resulting in recurrent chest infections
10% risk of developing malignancy, lymphoma or leukaemia, but also non-lymphoid tumours

auto recessive - mutation in ATM repair gene

335
Q

what are the features of dengue?

A

Fever, headache (often retro-orbital), myalgia, bone pain and arthralgia (‘break-bone fever’)

pleuritic pain
facial flushing (dengue)
maculopapular rash

haemorrhagic manifestations e.g. positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis

336
Q

which cell type is associated with hodgkins lymphoma and which marker does it have?

A

reed sternberg

CD15 and CD30

337
Q

what is the first line treatment for lymes disease?

A

First line treatment for early Lyme disease is a 14-21 day course of oral doxycycline

338
Q

what are the symptoms of lymes disease?

A

erythema migrans - bulls eye rash at site of tick bite.
develops 1-4 weeks post bite. usually painless

fever, headache, arhralgia

later - heart block, myocarditis, facial nerve palsy, meningitis

339
Q

what is the mechanism of action of donepezil? memantine?

A

anti-cholinergic - donepazil

memantine - NMDA receptor antagonist

340
Q

what is the contraindication of taking donepezil ? what are the ADRs of donepezil?

A

contraindicated in patients with bradycardia

ADR - insomnia

341
Q

what feature suggests that haematuria is glomerular in origin?

A

dysmorphic RBC on microscopy

342
Q

when are fatty urinary casts seen?

A

nephrotic syndrome

343
Q

how is oral morphine converted to subcut?

A

divide by 2

344
Q

how does TTP present?

A

pentand: fever, neuro signs, thrombocytopenia, haemolytic anaemia and renal failure

345
Q

what protein is involved in TTP?

A

reduced von Willebrand factor-cleaving proteases (ADAMTS13).

thrombi form from platelets

346
Q

which type of macular degeneration carries worst prognosis?

A

wet macular degeneration

347
Q

what blood electrolyte finding is found in cushings syndrome?

A

hypokalaemic metabolic alkalosis

348
Q

what is the management of gout?

A

NSAIDs or colchicine 1st line
NSAIDs avoided in elderly

urate lowering agents can be offered after 1st attack e.g. allopurinol - start at 100mg and titrate to aim for urate <300

349
Q

what is the most common side effect of colchicine?

A

diarrhoea

350
Q

In SLE, which Ab is associated with congenital heart block?

A

SLE - antibodies associated with congenital heart block = anti-Ro

351
Q

which Ab is associated with drug induced lupus?

A

anti-histone

352
Q

what are the symptoms of discontinuation syndrome for antidepressants?

A 
icreased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia
353
Q

what is Uhthoff ’s phenomenon?

A

Uhthoff ’s phenomenon where neurological symptoms are exacerbated by increases in body temperature is typically associated with multiple sclerosis

354
Q

what is the most common presenting symptom of MS?

A

tiredness

355
Q

which drugs precipitate G6PD deficiency?

A

primaquine
ciprofloxacin
sulphate containing drugs - sulphonamides etc
e.g. sulphonylureas - gliclazide, glimepiride

356
Q

which viral meningitis has a low CSF glucose?

A

MUMPS

357
Q

which antibody is dermatitis herpetiformis associated with?

A

HLA DR3

358
Q

what are the features of sleep paralysis?

A

Paralysis - this occurs after waking up or shortly before falling asleep
hallucinations - images or speaking that appear during the paralysis

359
Q

what antibody is seen in goodpastures?

A

anti- glomerular basement membrane

IgG

360
Q

which electrolyte disturbance can lead to cataracts?

A

hypocalcaemia

361
Q

what is the most common cause of congenital adrenal hyperplasia?

A

21 hydroxylase deficiency

362
Q

what pattern of inheritance is liddles? what are the features?

A

auto dominant - disorder of sodium channels in DCT
hypertension
hypokalaemic alkalosis

363
Q

which Abx causes Clostridium difficile?

A

Clindamycin

364
Q

what receptor does tamsulosin act on?

A

Alpha 1a

365
Q

what is charles bonnet syndrome?

A

hallucinations - visual or auditory

occur in normal consciousness/ cognition

366
Q

what is the equation for power of a study?

A

1 - type 2 error probability

367
Q

when in varienicline contraindicated? what is the mechnism of action?

A

self harm/ depression
pregnancy
breast feeding

nicotinic receptor partial agonist

368
Q

how does mercury poisoning present?

A 
paraeshtesia
visual changes
sensorineural hearing loss
irritable
renal tubular acidosis
369
Q

what is fabry disease?

A

X-linked recessive
deficiency of alpha-galactosidase A

Features
burning pain/paraesthesia in childhood
angiokeratomas
lens opacities
proteinuria
early cardiovascular disease
370
Q

which other drug should be avoided in aspirin allergy?

A

sulphasaalazine

371
Q

which recreational drug can lead to ischaemic colitis? How does this present?

A

cocaine (vasoconstrictor and can reduce blood flow to the gut)
abdo pain, bloody diarhoea
tachycardic , mydriasis (dilated pupil) - due to cocaine

372
Q

how is cocaine toxicity managed?

A
  1. benzos
    add
    - GTN for chest pain
    - sodium nitroprusside for HTN
373
Q

what are the features of hereitary haemorrhagic telangiectasia?

A

nose bleeds
telangiectasia around nose and lips
GI/pulmonary telangiectasia - can lead to bleeds
FHx

(autosomal dominant)

374
Q

what are the drug causes of retinopathy?

A

ethambutol, vigabatrin and amiodarone and hydroxychloroquine

375
Q

what is DC cardiovarsion synchronised with?

A

R wave

376
Q

what are the features of mastocytosis? How is this investigated?

A
  • urticaria pigmentosa - produces a wheal on rubbing (Darier’s sign)
    • flushing
    • abdominal pain
    • monocytosis on the blood film

raised urinary histamine
raised serum tryptase

377
Q

what is the first line Ix for lymes disease?

A

(ELISA) antibodies to Borrelia burgdorferi
repeat after 4-6 weeks if negative but high suspicion of lymes

immunoblot test for lymes can be done later to confirm

if erythema migrans is present - no need

378
Q

what is calciphylaxis? what drug exacerbates this?

A

linked to dialysis and high Ca/PO4/PTH
necrosis of skin secondary to arterial occlusion by calcium deposits.
painful skin lesions that are necrotic

exacerbated by warfarin

379
Q

what is sweets syndrome?

A

Sweet’s syndrome is also known as acute febrile neutrophilic dermatosis has a strong association with acute myeloid leukaemia

Small red bumps on The arms, neck, head and trunk
Sudden onset of fever
Bumps grow rapidly
Painful rashes

380
Q

which skin conditions are associated with diabetes?

A

Necrobiosis lipoidica - shiny, painless areas of yellow/red/brown skin typically on the shin. often associated with surrounding telangiectasia

 Infection- candidiasis, staphylococcal
Neuropathic ulcers
Vitiligo
Lipoatrophy
Granuloma annulare= papular lesions that are often slightly hyperpigmented and depressed centrally
381
Q

how does bullous pemphigoid present?

A

itchy rash
then develop into tense blisters
no mucosal invovlement
usually older patients

382
Q

when are platelet transfusions contraindicated?

A

TTP
heparin induced thromocytopenia
ITP
chronic bone marrow failure

383
Q

when are platelet transfusions adviced?

A

levels <10
levels <30 with bleeding / planned proceedure
levels <100 if severe bleeding/ intracranial bleed

384
Q

how are baby blues, post natal depression and puerpural psychosis differentiated?

A

baby blues 3-7days post birth - reassure
post natal depression - peaks at 3 months - reassure, CBT
peurpural psychosis- 2-3 weeks, mood swings, hallucinations/ dellusions - admit to hospital , mum and baby unit

385
Q

what are the causes of pulmonary eosinophilia?

A
  • Churg-Strauss syndrome
    • allergic bronchopulmonary aspergillosis (ABPA)
    • Loffler’s syndrome - parasitic infection and accumulation of eosinophils in lungs
    • eosinophilic pneumonia
    • hypereosinophilic syndrome
    • tropical pulmonary eosinophilia
    • drugs: nitrofurantoin, sulphonamides
    • less common: Wegener’s granulomatosis

NOT EXTRINSIC ALLERGIC ALVEOLITS

386
Q

what is the most common type of glomerulonephritis in adults and how does it present?

A

membranous

nephrotic usually

387
Q

which Ab is the idiopathic cause of membranous glomerulonephritis associated with?

A

anit-phospholipase A2

388
Q

how is membranous glomerulonephriits managed?

A

ACEi
steroids
+ cyclophosphamide if severe

389
Q

what is the mechanism of aciclovir?

A

inhibits DNA polymerase

activated by virally infected cells

390
Q

what are the predisposing factors for pagets disease?

A

age, male, northern lattitude, FHx

391
Q

what are the Ix findings in pagets?

A

high ALP
normal Ca/PO4
urinary hydroxyproline
Xray - osteolysis early , later thickening and osteoporosis. (pagets is due to excess osteoclasts followed by osteoblasts)

392
Q

what are the complications of pagets?

A

fractures
deafness
bone sarcoma
high output cardiac failure

393
Q

how does subacute thyroiditis present?

A

tender goitre
hyperthyroid clinical and bloods
reduced uptake via scan
high ESR

then euthyroid
then hypothryroid

all post infection

394
Q

what is ARVC (Arrhythmogenic right ventricular cardiomyopathy)? how does it present?

A

auto dominant - desmosome protien
right ventricle replaced by fibrofatty tissue
second most common cause of sudden cardiac death in young (after HOCM)

palpitations, syncope, sudden death

395
Q

what is Naxos disease?

A

autosomal recessive variant of ARCV .

triad of ARCV, palmoplantar ketatosis and woolly hair

396
Q

which zones does extrinsic allergic alvolitis affect? (e..g bird fanciers lung/ farmers lung)

A

upper / mid zone fibrosis

397
Q

what is the most common subtype of renal cell cancer?

A

clear cell

398
Q

what is the management for torsades de pointes?

A

IV MGSO4

399
Q

drugs to avoid in renal failure?

A

antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin

Drugs likely to accumulate in chronic kidney disease - need dose adjustment
most antibiotics
digoxin, atenolol
methotrexate
sulphonylureas
furosemide
opioids
400
Q

How do we test for Non fatty alcoholic liver disease?

A

ELF - enhanced liver fibrosis blood test - looks at a collection of markers to assess risk

401
Q

how is leprosy managed?

A

rifampicin, dapsone and clofazimine 12 months - for 6 or more lesions - multibacilary leprosy

For paucibacillary leprosy (5 or less lesions) you should give rifampicin and dapsone for 6 months.

402
Q

when does neuroleptic malignant syndrome happen?

A

usually from starting anti-psychotic

suddenly stopping dopaminergic drugs

403
Q

how is neuroleptic malignant syndrome managed?

A

stop antipsychotic
IV fluids
sometimes dantrolene
dopaminergic drugs- bromocriptine

404
Q

which HPV types are at risk of developing cervical cancer?

A

16,18,33

other risks:
smoking, human immunodeficiency virus, early first intercourse, many sexual partners, high parity, lower socioeconomic status and the use of the combined oral contraceptive pill.

405
Q

what is post concussion syndrome?

A

Post-concussion syndrome is seen after even minor head trauma

Typical features include
headache
fatigue
anxiety/depression
dizziness
406
Q

what is bumetanide?

A

loop diuretic

407
Q

what are the ECG changes in constrictive cardiomyopathy?

A

low voltage QRS

408
Q

how does wernickes and korsakoff present?

A

wernickes - opthalmoplegia (lateral rectus palsy and/or nystagmus), confusion and ataxia
korsakoff - anterograde amnesia and confabulation as well as above

409
Q

what is the management of acute angle glaucoma?

A

Alongside eye drops, IV acetazolamide is used in the initial emergency medical management of acute angle-closure glaucoma

410
Q

how is metastatic bone pain managed?

A

opioids, dexamethasone, radiation

411
Q

which proteins are affected in HOCM?

A

B myosin heavy chain or myosin binding protein C

412
Q

what are the features of HOCM?

A 
Features:
Exertional syncope
Angina 
Sudden death
Jerky pulse 
Ejection systolic murmur - increases with valsalva
413
Q

when should pneumococcal vaccine be given for splenectomys? which other vaccines are needed and which Abx prophylaxis?

A

2 weeks before op

- Hib, Men A &C 
- Annual influenza 
- Pneumococcal every 5 years

life long penicillin V

414
Q

what is the most common type of cyanotic CHD and when does it present?

A

tetralogy of fallot

presents around 1-2 months

415
Q

which organism is most common cause of osteomyeliits?

A

S.aureus

in sickle cell patients - salmonella species

416
Q

what is potts disease?

A

spinal TB - history of TB, back pain, fevers, weight loss

more common in thoracic and upper lumbar vertebrae

417
Q

how is epidiymo-orchitis managed?

A

• if the organism is unknown BASHH recommend:

ceftriaxone 500mg intramuscularly single dose, plus doxycycline 100mg by mouth twice daily for 10-14 days

418
Q

how does toxoplasmosis present?

A

lymphadenopathy , fever and malaise in immunocompetent host - self limiting

in immunocompromised - chorioretinitis, cerebral lesion

419
Q

how is cerebral toxoplasmosis managed?

A

pyrimethamine plus sulphadiazine for at least 6 weeks

420
Q

how does congential toxoplasmosis present?

A 
• neurological damage
		○ cerebral calcification
		○ hydrocephalus
		○ chorioretinitis
	• ophthalmic damage
		○ retinopathy
		○ cataracts
421
Q

how does optic neuritis present?

A

unilateral decrease in visual acuity over hours or days
poor discrimination of colours, ‘red desaturation’
pain worse on eye movement
relative afferent pupillary defect
central scotoma

associated with MS, diabetes and sphyllis

422
Q

how is optic neuritis managed?

A

high dose steroids

423
Q

what is the first line Ix for stable angina?

A

CT coronary angiography

424
Q

what are the ADRs of lithium?

A

nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus

thyroid enlargement, may lead to hypothyroidism

ECG: T wave flattening/inversion
weight gain
idiopathic intracranial hypertension
leucocytosis
hyperparathyroidism and resultant hypercalcaemia
425
Q

what is the management of PTSD?

A

watchful waiting - for mild symptoms lasting less than 4 weeks

trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases

venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline should be tried.

severe - risperidone

426
Q

what are the features of whipples disease?

A

HLA B27 , men
caused by infection

malabsorption, diarrhoea, 
large joint arthralgia
hypopigmentation
neurology
opthalmoplegia
427
Q

what are the Ix findings in whipples and what is the management?

A

jejunal biospy –> macrophages containing periodic acid schiff (PAS) granules

Mx:
- Co-trimoxazole - 1 year

428
Q

which antihistamines are non sedating/sedating?

A

sedating - chlorampheniramine

non - certirizine and loratidine
certirizine is more sedating than loratidine

429
Q

How does pompholyx eczema present?

A

type of eczema which causes tiny blisters to arise across the fingers, palms of the hands and in some cases the soles of the feet.
It commonly affects adults under 40 years old.

factors such as stress, sensitivity to metal compounds, sweating can aggravate it.

430
Q

what are the risks of chicken pox in pregnnacy?

A

fetal vericella syndrome
mother - pneumonitis

neonatal varicella - if mum gets chicken pox 5days before birth- 2 days after

431
Q

when is risk of fetal varicella syndrome highest and what are the symptoms?

A
  • Highest risk when exposure is before 20 weeks

Skin scarring, micropthalmia, limb hypoplasia, microcephaly and learning disability

432
Q

how is maternal chicken pox exposure managed?

A

check ab
<20 weeks - give VZIG asap
>20 weeks - give VZIG 7-14 days after

433
Q

what are the different types of amyloidosis?

A

AL - most common. associated with MGUS/ myeloma.

AA - associated with inflammation- TB/ RA

B2 microglobulin - associated with dialysis

434
Q

how is amyloidosis diagnosis?

A

congo red staining - apple green birefringence

435
Q

what is the treatment for facial hirsuitism?

A

topical eflornithine

436
Q

what is the management of spontaneous bacterial peritonitis?

A

IV cefotaxime

437
Q

what is the ECG changes in pericarditis?

A

PR depression - most specific

ST elevation saddle shaped, wide spread

438
Q

what are the aDRs of clozapine?

A

agranulocytosis
neutropaenia
reduced seizure threshold -

constipation
myocarditis: a baseline ECG should be taken before starting treatment
hypersalivation

439
Q

what are the main ADRs of ati-typical antipsychtocis?

A

increased stroke risk
VTE risk
weight gain
high prolactin

clozapine - agranulocytosis

olanzapine - higher risk of dyslipidaemia and obesity

440
Q

what colour is gram negative?

A

pink

441
Q

which Ab is seen in Wegners (granulomatosis with polyangiitis)?

A

cANCA

442
Q

how is mycoplasma pneumonia diagnosed?

A

serology

443
Q

what are the causes of papilloedema?

A 
space occuping lesion
malignant hypertension
idiopathic intracranial HTN
hydrocephalus
hypercapnia

rare - vit A toxicity, hypo PTH/ hypoCa

444
Q

What are the ADRs of SSRIs?

A

GI symptoms
GI bleed - take with PPI if also on NSAIDs. avoid if on warfarin
hyponatraemia
citalopram - increase QT

445
Q

which SSRI has greatest risk in pregnancy?

A

risk of pulmonary HTN if used in T3.

paroexetine has most risk of congenital malformations

446
Q

what type of bacteria in klebsiella? Who is it most common in? and what distinguishing feature is present in patients?

A

gram neg rod

common in alcoholic/diabetic/ aspiriation

red current jelly sputum. Affects upper lobes

447
Q

what type of pneumothorax is seen in menstruating women?

A

catamenial pneumothorax

448
Q

what are the side effects of phosphodiesterase inhibitors?

A

visual disturbances - blue discolouration

non-arteritic anterior ischaemic neuropathy

nasal congestion
 flushing
gastrointestinal side-effects
headache
priapism
449
Q

what are the features of leptospirosis?

A

fever, flu like , subconjunctival haemorhage/
AKI
hepatitis / hepatomegaly
aseptic meningitis

Bilateral conjunctivitis, bilateral calf pains and high fevers

450
Q

how is leptospirosis managed?

A

high dose benzylpenicillin doxy

451
Q

how does japenese encephalitis present?

A

The majority of infection is asymptomatic.

Clinical features are headache, fever, seizures and confusion.
Parkinsonian features indicate basal ganglia involvement.
It can also present with acute flaccid paralysis.

452
Q

which medication for paliative patients can treat bowel colic?

A

respiratory secretions & bowel colic may be treated by hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide.

can be put in syringe driver

453
Q

which drug is incompatiable with many other drugs in a syringe driver?

A

cyclizine

454
Q

what is the genetics behind osteogenesis imperfecta?

A

auto dom

type 1 collagen

455
Q

what are the features of osteogenesis imperfecta?

A

blue sclera
fractures
deafness - otosclerosis
dental imperfections

456
Q

what are the different occular problems associated with RA?

A

keratoconjunctivitis sicca - most common

episcleritis - erythema, no pain

scleritis - erythema and pain
corneal ulcers
keratitis

457
Q

what is pathogenesis of PKU?

A

auto recessive
phenylalanine hydroxyalase mutation
(normally converts phenylalanine to tyrosine)

458
Q

what are the features of PKU?

A 
developmental delay
fair hair and blue eyes
seizures - infantile spasms
musty odour to urine and sweat
eczema
459
Q

how is dermatitis herpetiformis. manaaged?

A

dapsone

460
Q

what is most common cause of pneumonia in COPD?

A

Haemophilus influenza

461
Q

what causes papilloedema of one optic disc and atrophy of the other?

A

frontal lobe lesion - ipsilateral atrophy of optic disc and contralateral papilloedema = Foster-Kennedy syndrome
usually caused by meningioma

462
Q

what is the normal QTc in men and women?

A

men <450

women <470

463
Q

what are the features of chinchonism?

A

quinine toxicity

  • long QT/ QRS –> VT VF
  • pulmonary oedema
  • tinnitus
  • blurring of vision
  • dry skin, abdo pain
  • hypglycaemia
  • metabolic acidosis
  • hypotension
464
Q

what is the functions of terbinifene, azoles, nystatin?

A

azoles - Inhibits 14α-demethylase which produces ergosterol

terbinifene - Inhibits squalene epoxidase

nystatin - Binds with ergosterol forming a transmembrane channel that leads to monovalent ion leakage

465
Q

what is the secondary prevention after MI?

A

dual antiplatelet:

  • ticagrelor and aspirin (stop ticagrelor after 12 months)
  • if PCI then prasugrel or ticagrelor + aspirin.

ACEi, B blocker, statin.

if HG - left ventricular dysfunction then add in aldosterone antagonist (epleronone)

466
Q

What are the features of frontotemporal lobar dementia ?

A

onset <65
insidious
preserved memory and visuospatial skills
personality change and social conduct problems

often family Hx.

467
Q

what is picks disease?

A

most common type of frontotemporal dementia
characterised by imparied social impairment, personality change, disinhibition, increased appetite

Atrophy of frontal and temporal lobes

468
Q

what is the condition called where there is compression of the lateral cutaneous nerve of the thigh?

A

meralgia paraesthesia

469
Q

list different haemorrgahic fever causes

A

dengue, yellow fever
Lassa fever
Ebola virus, Marburg virus

Hantaviruses, Crimean-Congo haemorrhagic fever, Rift Valley fever

470
Q

what organism carries lassa fever?

A

rats
in africa
(also spreafd person to person)

471
Q

what organism carries marburg virus?

A

in caves

bats and primates

472
Q

which animal carries leishmaniasis?

A

sandflies

473
Q

beta carotine is an anti-oxidant. who shouldnt take this and why?

A

smokers - increases risk of lung cancer

474
Q

what is the best blood marker of severity of acute pancreatitis?

A

CRP now recomended

correlates with necrosis

475
Q

what are the ECHO findings of HOCM?

A

mitral regurgitation (MR)

systolic anterior motion (SAM) of the anterior mitral valve leaflet

asymmetric hypertrophy (ASH)

476
Q

which diabetic meds are linked to severe pancreatitis and renal impairment?

A

Exanatide

477
Q

how is lewy body dementia and parkinsons diagnosed?

A

SPECT scan

478
Q

which blood test is important for restless leg syndrome?

A

serum ferritin

479
Q

how does an iliopsoas abscess present?

A

fever and pain on hip extension

480
Q

which organism is most common in iliopsoas abscesses?

A

S.aureus

481
Q

which is the most common type of glomerulonephritis in wegners/ granulomatosis with polyangiitis? how does it present? what is seen on biopsy?

A

rapidly progressive glomerulonephritis, with its severe and rapid loss of kidney function, haematuria and proteinuria. A renal biopsy demonstrates glomerular crescents.

482
Q

what are the ADRs of bisphosphonates?

A
  • oesophageal reactions: oesophagitis, oesophageal ulcers (especially alendronate)
    • osteonecrosis of the jaw
    • increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate
    • acute phase response: fever, myalgia and arthralgia may occur following administration
    • hypocalcaemia: due to reduced calcium efflux from bone. Usually clinically unimportant
483
Q

which antibody is found in mixed connective tissue disease?

A

anti-RNP

484
Q

how can the cause of horners determine the location of compression (central, pre ganglionic, post ganglionic)

A

Anhidrosis of the face, arm and trunk = central lesion = stroke, syrignomyelia, MS, tumour, encephalitis

Anhidrosis of the face = preganglionic lesion - pancoast tumour, thyroidectomy, trauma, cervical rib

No anhidrosis = post ganglionic - Carotid artery dissection, Carotid aneurysm, Cavernous sinus thrombosis, Cluster headache

485
Q

what is the first line for guillian barre?

A

IV IG

486
Q

what are the contraindications to breast feeding?

A

galactosaemia
certain viral infections

The following drugs should be avoided:
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
487
Q

how does otosclerosis present?

A 
Onset is usually at 20-40 years - features include:
conductive deafness
tinnitus
normal tympanic membrane*
positive family history
488
Q

which drugs cause steven johnson syndrome?

A 
penicillin
sulphonamides - any sulphur containing stuff
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill
489
Q

what is the pathogenesis behind porphyria cutanea tarda?

A

uroporphyrinogen decarboxylase defect - inherited
OR acquired from hepatocyte damage

defect in haem production

490
Q

what are the symptoms of porphyria cutanea tarda?

A

photosensitive blistering rash
hypertrichosis (hair growth)
hyperpigmentation

491
Q

how long is serum tryptase elevated after anaphylaxis?

A

12 hours

492
Q

which drugs lead to glucose intolerance?

A 
Steroids
tacrolimus / ciclosporin
nicotinic acid
thiazides
IFNa
antipsychotics
(B blockers)
493
Q

what are the complications of plasma exchange:

A
  • hypocalcaemia
    • metabolic alkalosis
    • removal of systemic medications
    • coagulation factor depletion
    • immunoglobulin depletion
494
Q

what are the features of goodpastures? what is found on biopsy?

A

pulmonary haemorrhage

rapidly progressive glomerulonephritis- this typically results in a rapid onset acute kidney injury
○ nephritis → proteinuria + haematuria

IgG deposits on BM

495
Q

what murmur is found in an ASD?

A

ejection systolic , louder on inspiration

496
Q

what is the management of organophosphate poisoning?

A

atropine

497
Q

what are the symptoms of organophosphate poisoning?

A

headache, disorientation, weakness, vomiting, and muscarinic effects such as miosis, bradycardia and increased urination, lacrimation

498
Q

what Abx is used in tetanus?

A

metronidazole

499
Q

what medication can be used in acute delirium?

A

haloperdol (not benzos - can worsen)

500
Q

what are the associations to WPW?

A

Associations with WPW:

  • Thyrotoxicosis
  • Mitral valve prolapse
  • Ebstein anomaly
  • HOCM
  • Secundum ASD
501
Q

what are the features of von hippau lindau?

A

cerebellar haemangiomas: these can cause subarachnoid haemorrhages

retinal haemangiomas: vitreous haemorrhage

renal cysts (premalignant)
phaeochromocytoma
extra-renal cysts
clear-cell renal cell carcinoma

502
Q

how much should non-HDL be reduced by after starting statins?

A

> 40%

503
Q

what are the symptoms of visceral leishmaniasis?

A 
fever, sweats, rigors
massive splenomegaly. hepatomegaly
poor appetite*, weight loss
grey skin - 'kala-azar' means black sickness
pancytopaenia secondary to hypersplenism
504
Q

What are the ADRs of azothioprine?

A

bone marrow depression
consider a full blood count if infection/bleeding occurs
nausea/vomiting
pancreatitis
increased risk of non-melanoma skin cancer

505
Q

can azothioprine be used in pregnancy?

A

yes, as well as mesalazine and sulfasalazine

506
Q

what are the features of alports syndrome? what is the genetic defect?

A
  • Microscopic haematuria
    • Bilateral sensorineural hearing loss
    • Renal failure
    • Lenticonus - protrusion of lens
    • Retinitis pigmentosa
      Renal biopsy - splitting of lamina densa seen on electron microscope

X linked dominant - collagen IV

507
Q

what are the ADRs of ciclosporin?

A

nephrotoxicity
hepatotoxicity

everything increased:
fluid retention
hypertension
hyperkalaemia
hypertrichosis
gingival hyperplasia
tremor
impaired glucose tolerance
hyperlipidaemia
increased susceptibility to severe infection
508
Q

which lens dislocation is seen in marfans/ homocysteinuria?

A

marfans - upward

homocysteinuria - downward

509
Q

which antibodies are present in dermatomyositis?

A

the majority of patients (around 80%) are ANA positive

around 30% of patients have antibodies to aminoacyl-tRNA synthetases (anti-synthetase antibodies), including: anti jo, Anti SRP, anti-Mi-2 antibodies

510
Q

how does acne roseca present and how is it treated?

A 
typically affects nose, cheeks and forehead
flushing is often first symptom
telangiectasia are common
rhinophyma
ocular involvement: blepharitis
sunlight may exacerbate symptoms/

Management
topical metronidazole may be used for mild symptoms more severe disease is treated with systemic antibiotics e.g. Oxytetracycline

511
Q

what are the side effects of EPO?

A 
HTN
bone aches
flu like symptoms
red cell aplasia 
skin rash/urticaria

iron deficiency secondary to erythropoeisis

512
Q

what is seen on renal biopsy in alports?

A

ongitudinal splitting of the lamina densa of the glomerular basement membrane, resulting in a ‘basket-weave’ appearance

513
Q

how often is lithium checked? what else should be checked?

A

weekly until stable and then every 3 months

thyroid and renal function every 6 months

514
Q

what is blocked in cyanide poisoning and what are the features?

A

cytochrome c oxidase

brick red skin
bitter smell
hypoxia. hypotension, headache

515
Q

how is relative risk calculated?

How is relative risk reduction calculated?

A

% of new drug effect/ % of placebo

RRR = % of new drug - % placebo / % placebo

516
Q

what blood result is found in chronic Hep B infection?

A

The negative IgM anti-HBc points to a chronic rather than acute infection.
Positive anti-HBc IgG, negative anti-HBc IgM
postive HBs antigen

anti HBs = immunity. This is negative in chronic disease

517
Q

which scoring system is used for liver cirrhosis and what paramets does it include?

A

Child pugh - for severity.

billiruubin, albumin, PT, encephalopathy, ascites

Model for end stage liver disease (MELD) scoring = predicts survival (INR, bilirubin,creatinine)

518
Q

what is the classic symptoms of pre-eclampsia?

A

new-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy
AND 1 or more of the following:
proteinuria (oedema)
other organ involvement e.g. renal insufficiency (creatinine ≥ 90 umol/L), liver, neurological, haematological, uteroplacental dysfunction

519
Q

How is initial RA diagnosis managed? how is the response to treatment monitored?

A

DMARD monotherapy + steroids

monitored via CRP and DAS28

520
Q

howis absolute risk reduction calculated and numbers needed to treat?

A

absolute RR = % test - %control

NNT = 1/ ARR

521
Q

how is MS managed?

A

high dose steroids (IV / oral methylpred) - 5 days (this shortens relapse)

Reducing relapse - B IFN

fatigue - amantidine
spacsticity - baclofen/ gabapentin.

Oscillopsia - gabapentin.

522
Q

how does polyarteritis nodosa present?

A 
Fever, malaise, arthralgia
weight loss
hypertension
mononeuritis multiplex, sensorimotor polyneuropathy
testicular pain
livedo reticularis
haematuria, renal failure
pANCA
hepatitis B serology positive in 30% of patients
523
Q

what is lithium toxicity precipitated by?

A

dehydration
renal failure
drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.

524
Q

what drug should be used if patients cant tolerate alendronate?

A

switching to risedronate or etidronate in patients unable to tolerate alendronate

525
Q

what should be checked before starting azothioprine?

A

thiopurine methyltransferase deficiency (TPMT) before treatment
deficiency leads to toxicity

526
Q

which tumour is associated with anti NMDA (autoimmune encephalitis). what are the features of this?

A

ovarian teratoma

psychiatric features including agitation, hallucinations, delusions

527
Q

how does eosinophilic oesophagitis present?

A

young men with symptoms of dysphagia and in patients with a history of food allergy, eczema and asthma

528
Q

what are the hormonal changes in annorexia?

A

Low FSH, LH, oestrogens and testosterone

raised cortisol and growth hormone

529
Q

what features suggest it will be an VT rather than SVT?

A
  • AV dissociation
    • fusion or capture beats
    • positive QRS concordance in chest leads
    • marked left axis deviation
    • history of IHD
    • lack of response to adenosine or carotid sinus massage
    • QRS > 160 ms
530
Q

how can eye drops be used to distinguish between the lesion of horners?

A

Apraclonidine eye drops are initially used to confirm a Horner’s pupil. Apraclonidine stimulates both alpha-1 and alpha-2 receptors. When added to the affected eye, it causes pupil dilation by >2mm because of the relative supersensitivity of this pupil to alpha-1 receptor activity. In a normal pupil, however, it causes constriction due to the more potent activity at the alpha-2 receptor which triggers reuptake of noradrenaline in the synaptic cleft.

Hydroxyamphetamine is then used to distinguish between first/second or third order neurones. In a normal pupil or a first/second order Horner’s, the pupil will dilate. In a third order neurone lesion, this will not occur.

531
Q

what are the contraindications to TB vaccine?

A

• previous BCG vaccination
• a past history of tuberculosis
• HIV
• pregnancy
• positive tuberculin test (Heaf or Mantoux)
The BCG vaccine is not given to anyone over the age of 35, as there is no evidence that it works for people of this age group.

532
Q

wahat is malingering?

A

faking illnes for gain - e.g. financial gain (whiplash) or pain releif meds

533
Q

causes of raised anion gap?

A

lactate: shock, hypoxia
ketones: diabetic ketoacidosis, alcohol
urate: renal failure
acid poisoning: salicylates, methanol
5-oxoproline: chronic paracetamol use

534
Q

causes of normal anion gap?

A 
gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison's disease
535
Q

what are the poor prognostic factors of schizophenia?

A 
low IQ
family Hx
insideious onset
prodromal phase of social withdrawl 
lack of obvious precipitant
536
Q

what leads to coagulation in nephrotic syndrome?

A

loss of ATIII

537
Q

strongest risk factor for dry age related macular degeneration?

A

smoking

538
Q

what are the ADRs of aromatase inhibitors?

A

osteoporosis- NICE recommends a DEXA scan when initiating
hot flushes
arthralgia, myalgia
insomnia

539
Q

what is mechanism and side effect of tamoxifen?

A

Tamoxifen is a SERM which acts as an oestrogen receptor antagonist and partial agonist.

Adverse effects
menstrual disturbance: 
hot flushes -
venous thromboembolism
endometrial cancer
540
Q

what is an example of an aromatase inhibitor?

A

Anastrazole

541
Q

what causes cannon a waves?

A
  • Caused by right atrium contracting against a closed tricuspid valve
    • Regular:
      ○ VT
      ○ AVNRT
    • Irregular
      ○ Complete heart block
542
Q

how do B blockers (timolol) in acute angle glaucoma work?

A

by reducing aqueous production

543
Q

what is seen in Seborrhoeic dermatitis?

A

otitis externa and blethritis

eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds

544
Q

what is the mechanism of action of acarbose?

A

Acarbose is an inhibitor of intestinal alpha glucosidases, which results in decreased absorption of starch and sucrose.

common side effect = flatulence

545
Q

what type of cancer is schistosomiasis infection linked to ?

A

squamous cell bladder

546
Q

How does schistosomiasis infection present acutely?

A

swimmers’ itch
acute schistosomiasis syndrome (Katayama fever)
fever, urticaria/angioedem, arthralgia/myalgia, cough, diarrhoea, eosinophilia

547
Q

what are the chronic issues of schistosomiasis?

A

Schistosoma mansoni and Schistosoma japonicum - liver/ colon infestation, hepatomegaly, splenomegaly. cirrhosis, variceals, cor-pulmonale.

Schistosoma haematobium - bladder cancer

548
Q

who is benign ethnic neutropenia seen in?

A

Benign ethnic neutropaenia is common in people of black African and Afro-Caribbean ethnicity
isolated neutropenia - no issues

549
Q

which infection is associated with struvite stones?

A

Proteus mirabilis

550
Q

what is the genetics behind freidrich ataxia?

A

autorecessive
trinucleotide repeat
doesnt have anticipation

551
Q

what are the features of friedrich ataxia?

A

absent ankle jerks/extensor plantars
cerebellar ataxia
spinocerebellar tract degeneration

optic atrophy
high arched palate

HOCM
diabetes
10-15yrs

552
Q

what is the difference in impaired fasting glucose and impaired glucose intolerance pathophysiology?

A

Impaired fasting glucose (IFG) - due to hepatic insulin resistance
impaired glucose tolerance (IGT) - due to muscle insulin resistance
patients with IGT are more likely to develop T2DM and cardiovascular disease than patients with IFG

553
Q

which occular pathology is associated with charles bonnet syndrome?

A

Age-related macular degeneration is associated with Charles-Bonnet syndrome (visual hallucinations, patient aware and no psych problems)

554
Q

what is the conversion of oral morphine to s/c diamorphine?

A

divide by 3

555
Q

what is the most common sign on USS in gout?

A

double-contour sign
= a hyperechoic, irregular band over the superficial margin of the joint cartilage, produced by deposition of monosodium urate crystals on the surface of the hyaline cartilage,

556
Q

what is the power of a study?

A

probability of detecting a significant difference.

i.e. rejecting the null correctly

557
Q

what is the investigation for pheochromocytoma?

A

Phaeochromocytoma: do 24 hr urinary metanephrines, not catecholamines

558
Q

what is mcardles disease?

A

autosomal recessive type V glycogen storage disease

this causes decreased muscle glycogenolysis

Features
muscle pain and stiffness following exercise
muscle cramps
myoglobinuria
low lactate levels during exercise
559
Q

what is the treatment for cryptosporidiosis for immunocompromised patients?

A

Nitazoxanide

560
Q

what happens to clotting factors in liver disease?

A

most low

factor 8 is normal/ raised

561
Q

what conditions are associated with IgA nephropathy?

A

alcoholic cirrhosis
coeliac disease/dermatitis herpetiformis
Henoch-Schonlein purpura

562
Q

what does the A wave on JVP present and what abnormalities are associated with it?

A

atrial contraction (first wave on JVP)

large if there is high atrial presssure e.g. tricuspid/pulmonary stenosis, pulomnonary HTN.

cannon a waves - contracts against closed tricuspid e.g. complete heart block

Absent in AF.

563
Q

what does the C wave on JVP present?

A

2nd wave on JVP

closure of tricuspid. not always visible

564
Q

what does the V wave on JVP present and what abnormalities are associated with it?

A

Third increase wave on JVP .
due to passive filling of atria .

giant v waves in tricuspid regurg.

565
Q

what does the x and y descent represent on JVP?

A

X decent - after c wave.
fall in pressure due to ventricular systole

y decent after v wave - opening of tricuspid valve

566
Q

what is rieldel thyroiditis?

A

rare cause of hypothyroidism
dense fibrois tissue replaces normal thyroid
appears hard and painless goitre
middle aged women
either euthyroid (most cases) or hypothyroid.

567
Q

what is reidels thyroiditis associated with?

A

retroperitoneal fibrosis

568
Q

after starvation, how is food reintroduced to avoid refeeding syndrome?

A

NICE recommend that if a patient hasn’t eaten for > 5 days, aim to re-feed at no more than 50% of requirements for the first 2 days.

569
Q

when is calcification of lung mets seen?

A

only if there is chondrocarcinoma or osteosarcoma

570
Q

when are eruptive xanthomas most common?

A

high triglycerides - familial hypertriglyceridaemia

also lipoprotein lipase deficiency

571
Q

what organism causes syphilis?

A

Treponema pallidum

572
Q

how is syphilis tested for?

A

non-treponemal tests
(cardiolipin test) - e.g. RPR and VDRL - these become negative after treatment.

Treponemal specific tests - TPHA and TP-EIA - stay positive after treatment.

573
Q

how can the syphilis tests be interupted?

A

Positive non-treponemal test + positive treponemal test
• consistent with active syphilis infection

Positive non-treponemal test + negative treponemal test
• consistent with a false-positive syphilis result e.g. due to pregnancy or SLE

Negative non-treponemal test + positive treponemal test :
• consistent with successfully treated syphilis

574
Q

what are the causes of false positive non-treponemal tests?

A 
SLE
pregnnacy
HIV
TB
Malaria
leprosy
575
Q

what is the mechanism of pilocarpine?

A

Pilocarpine is a muscarinic receptor agonist
used in gaulcoma

increases uveoscleral outflow by constricting the pupil.

576
Q

how is metformin initiated?

A

start at 500mg and titrate slowly. minimum interval for titration = 1 week

577
Q

what are the risk factors for adenocarcinoma of oesophagus and squamous cell carcinoma?

A

squamous: smoking, alcohol, achalasia and plummer vinson

adeno - smoking, alcohol, barrets

578
Q

how do angioid retinal steaks appear?

what conditions is this associated with?

A

irregular dark red streaks from optic nerve

associated with ehlers danlos, acromegaly, pagets, sickle cell, pseudoxanthoma elasticuum

579
Q

what is hungry bone syndrome?

A

after srugery to treat hyperparathyoidism there is a sudden drop in PTH
this results in bones absorbing a lot of calcium
hypoCa

580
Q

which antiepileptics are safe in breast feeding?

A

Most are safe

except barbiturates

581
Q

how does primary infection with herpes present?

A

gingivostomastitis - ulcers and oral inflammation. swelling of submandibular gland.
plus fever/ unwell

582
Q

how are SSRIs stopped?

A

withdraw slowly over 4 weeks

not necessary with fluoexetine due to longer half life

583
Q

what is the genetics behind gilberts?

A

autorecessive.
defective bilirubin conjungation
deficiency in UDP glucuronosyltransferase

584
Q

how is gilberts tested for?

A

rise in bilirubin following prolonged fasting or IV nicotinic acid

585
Q

how are babies who’s mum has chronic hep B managed?

can mum breast feed?

A

vaccine and IVIG given to baby

little evidence for need for c section
cant be transmitted via breast milk

586
Q

What organism causes rocky mountain fever ? how does it present?

A

Rocky mountain fever = Rickettsia ricketsii

headache, fever, rash (starts on peripheries and spreads centrally)

587
Q

What organism causes Q fever ? how does it present?

A

Q fever= Coxiella burnetti

No rash but causes pneumonia

588
Q

What organism causes endemic typhus ? how does it present?

A

ndemic typhus Rickettsia typhi

Rash starts centrally then spreads to the peripheries

589
Q

What organism causes epidemic typhus ? how does it present?

A

Epidemic typhus

Rickettsia prowazekii

590
Q

what are the poor prognostic factors following ACS?

A 
age
development (or history) of heart failure
peripheral vascular disease
reduced systolic blood pressure
Killip class*
initial serum creatinine concentration
elevated initial cardiac markers
cardiac arrest on admission
ST segment deviation
591
Q

what is the killip class?

A 
risk straification post MI 
1 - no HF signs
2- lung crackles, S3
3 - frank pulmonary oedema
4 - cardiogenic shock
592
Q

what is the management of acne?

A 
topical retiniod 
topical antibiotic
oral therapy
   - tetracyclines - use for max 3 mont
COCP
oral isotretinoin
593
Q

which antibiotics for ACNE are safe in pregnancy?>

A

erythromycin

594
Q

which acne medication causes irreversible pigmentation?

A

minocycline

595
Q

what are the indications for steroids in sarcoidosis?

A

CXR 2 or 3 disease and symptomatic
hypercalcaemia
eye, heart, or neuro involvement

596
Q

how is haemochromatosis diagnosed?

A

transferrin saturation
ferritin levels
(low total iron binding content)

family members - HFE gene mutation

597
Q

which cancer are the following skin conditions associated with?

Erythema gyratum repens
acanthosis nigricans
dermatomyosis 
migratory thrombophlebitis
necrolytic migratory erythema
A

erythema gyratum repens - lung cancer

acanthosis nigricans - gastric cancer

dermatomyositis - ovarian and lung cancer

Migratory thrombophlebitis - Pancreatic cancer

Necrolytic migratory erythema Glucagonoma

598
Q

what is the mechanism of warfarin?

A 
inhibits epoxide reductase - stops vit K reduction
inhibits factors (1972)
599
Q

can warfarin be used in pregnancy and breastfeeding?

A

yes breastfeeding

600
Q

what factors can increase warfarin?

A

liver disease
P450 enzyme inhibitors, e.g.: amiodarone, ciprofloxacin
cranberry juice
drugs which displace warfarin from plasma albumin, e.g. NSAIDs
inhibit platelet function: NSAIDs

601
Q

what is the target for statin therapy in primary prevention?

A

In the primary prevention of CVD using statins aim for a reduction in non-HDL cholesterol of > 40%

602
Q

which type of testicular tumour is associated with rise in hCG?

A

seminoma - just hCG raised
choriocarcinoma - but much rarer than above
yolk sac tumours - hCG and alpha fetoprotein both rasised

603
Q

how is phenytoin toxicity/ levels measured?

A

just before next dose

604
Q

which scoring system is used for appendaidictis?

A

The Alvarado score can be used to suggest the likelihood that a patient has acute appendicitis

605
Q

which Ab are found in SLE

A

ANA - 95% - sensitive, not specific

Anti DsDNA/ anti smith - specific not sensitive

606
Q

what are the ECG changes in arryhthmogenic RV cardiomyopathy?

A

ECG abnormalities in V1-3, typically T wave inversion. An epsilon wave is found in about 50% of those with ARV - this is best described as a terminal notch in the QRS complex

607
Q

what are the features of ebstein anomoly?

A

cyanosis
prominent ‘a’ wave in the distended JVP,
hepatomegaly
tricuspid regurgitation - giant V wave in JVP
pansystolic murmur, worse on inspiration
right bundle branch block → widely split S1 and S2

608
Q

how are wounds treated in regards to tetanus if they completed vaccine >10yrs ago?

A

tetanus prone wound - reinforcing vaccine dose

high risk wound - reinforcing vaccine dose + Ig

609
Q

what are the causes of avascular necrosis of the hip?

A

steroids
chemo
alcohol
trauma

610
Q

which anti-epileptic can cause agranulocytoiss?

A

carbemazepine

611
Q

how does a left venticular aneurysm post MI present?

A

persistent ST elevation
no chest pain
signs of HF

612
Q

how long is needed for a fistula to develop?

A

6-8 weeks

613
Q

How is cryptosporidium diagnosed

A

Cryptosporidium can be diagnosed by modified Ziehl-Neelsen staining of stool to reveal red cysts

614
Q

what mode of inheritance is alports?

A

auto dominant

collagen type 4

615
Q

what are the features of alports?

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 - basket weave appearance

616
Q

whats the difference between docetaxel and vincistrine?

A

docetaxel - prevents microtubule dissasembly

vincistrine - prevents microtubule formation

617
Q

In patients with low K and HTN, how can we differentiate the causes?

A

renin:aldosterone

  • both high = renal artery stenosis
  • aldosterone high, renin low = primary hyperaldosteronism
  • neither high = liddles.
618
Q

what are the characteristics of Argyll robertson pupils? what are the cuases?

A

small, irregular pupils
no light response
but there is accomodation response

causes - diabetes and syphillis

619
Q

when is vitamin D deficiency treated?

A

<30

620
Q

which movement is most classically impaired in adhesive capsulitis?

A

external rotation

621
Q

how long after initial infection of C.diff is oral vanc used again?

A

1st line = oral vanc
reinfection after 12 weeks - oral vanc
within 12 weeks - oral fidaxomicin

622
Q

what is the diagnosis for obstructive sleep apnoea?

A

Polysomnography

623
Q

what are the secondary causes of hypercholesterolaemia over hypertriglyceridaemia?

A

nephrotic syndrome, cholestasis, hypothyroidism

624
Q

what is the action of dipyrimadol?

A

inhibits phosphodiesterase, elevating platelet cAMP levels which in turn reduce intracellular calcium levels

other actions include reducing cellular uptake of adenosine and inhibition of thromboxane synthase

625
Q

what abnormal observation should not be treated following acute stroke?

A

HTN

626
Q

when are angiod retinal streaks seen?

A 
pseudoxanthoma elasticum
Ehler-Danlos syndrome
Paget's disease
sickle-cell anaemia
acromegaly
627
Q

what is Bevacizumab

A

monoclonal against VEGF

628
Q

what is the management of eosinophilic oesophagiits?

A

Dietary modification and topical steroids are used in the management of eosinophilic oesophagitis

629
Q

what are the side effects of ECT?

A 
Short-term side-effects
headache
nausea
short term memory impairment
memory loss of events prior to ECT
cardiac arrhythmia

Long-term side-effects
some patients report impaired memory

630
Q

Which Abx promotes MRSA?

A

ciprofloxacin

631
Q

what is pseudohypoparathyroidism ?

A

Pseudohypoparathyroidism is caused by target cell insensitivity to parathyroid hormone (PTH) due to a mutation in a G-protein.
autosomal dominant fashion*

632
Q

what are the features of pseudohypoparathyroisim?

A

Bloods
PTH: high
calcium: low
phosphate: high

Features
short fourth and fifth metacarpals
short stature
cognitive impairment
obesity
round face
633
Q

how is raynauds managed?

A

CAB - nifedipine

Epoprostenol (amongst other prostaglandins)

634
Q

what is the cause of endocarditis in prosthetic valves?

A

<2 month hx of surgery - epidermidis

>2 month - S.aureus

635
Q

what defines pulmonary artery HTN?

A

Pulmonary arterial hypertension is defined as an elevated pulmonary arterial pressure of greater than 25mmHg at rest or 30mmHg after exercise

636
Q

what medication should all SLE patients take?

A

hydroxychloroquine

637
Q

which operations are available for weight loss and when?

A

Primarily restrictive operations
laparoscopic-adjustable gastric banding (LAGB)
it is normally the first-line intervention in patients with a BMI of 30-39kg/m^2
produces less weight loss than malabsorptive or mixed procedures but as it has fewer complications

Primarily malabsorptive operations
biliopancreatic diversion with duodenal switch
usually reserved for very obese patients (e.g. BMI > 60 kg/m^2)

Mixed operations
Roux-en-Y gastric bypass surgery
is both restrictive and malabsorptive in action

638
Q

which zones of the lung does asbestosis causing fibrosis affect?

A

lower zone

639
Q

how is occulogyric crisis managed?

A

intravenous antimuscarinic: benztropine or procyclidine

640
Q

at what pottasium level is ramipril stopped?

A

stop ramipril at K+ >6

641
Q

how is a cerebral abscess managed?

A

IV antibiotics: IV 3rd-generation cephalosporin + metronidazole
intracranial pressure management: e.g. dexamethasone

642
Q

what are the contraindications to lung cancer surgery?

A

SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis

643
Q

what type of glomerulonephritis is heroin associated with?

A

focal segmental glomerulosclerpsois

644
Q

what are the genetics behind bruguda syndrome?

A

mutation in the SCN5A gene which encodes the myocardial sodium ion channel protein
autosomal dominant

645
Q

what are the features and management of bruguda?

A

convex ST segment elevation V1-V3 followed by a negative T wave
partial right bundle branch block
the ECG changes may be more apparent following the administration of flecainide

ICD= management

646
Q

what is the inheritance of myotonic dystrophy?

A

auto dominant
Trinucleotide repeat
DM1 and DM2

647
Q

what are the features of myotonic dytrophy?

A

distal weakness - DM1
proxinal weakness - DM2
myotonic facies, diabetes, bilateral ptosis , cataracts, dysarthria, heart block

648
Q

which drugs precipitate acute intermittent porphyria?

A 
barbiturates
halothane
benzodiazepines
alcohol
oral contraceptive pill
sulphonamides
649
Q

what blood test abnormalities are associated with antiphospholipid syn?

A

thrombocytopenia

prolonged APTT

650
Q

what are the ADRs of PPIs?

A

hypo Mg/ Na
microscopic colitis
Cdif
osteoporosis

651
Q

what are the features of cholesterol emboli?

A

eosinophilia
purpura
renal failure
livedo reticularis

652
Q

what should be checked if a man has osteoporosis?

A

testosterone

653
Q

what anti-psychotic is contraindicated in parkinsons?

A

Haloperidol

654
Q

what viruses could cause eczema herpeticum?

A

HSV and less commonly coxsackie

655
Q

which is the most common and severe form of renal diseae in SLE?

A

diffuse proliferative glomerulonephritis

656
Q

how long can you not drive for after angioplasty?

A

1 week

657
Q

what are the genetics behind familial mediterranean fever?

A

auto recesive

in turkey/ arabic decent

658
Q

what are the features of familial mediterraean fever?

A

pyrexia, abdo pain, pleurisy, pericarditis, artritis, rash

colchicine helps

659
Q

what is the most common type of hodgkins lymphoma?

A

nodular sclerosing

660
Q

what type of hodgekin lymphoma has worst prognosis?

A

lymphocyte deplete

661
Q

what arises first in MI?

A

myoglobin

662
Q

what conditions are associated with sebhorreic dermatitis and how is it treated?

A

HIV
parkinsons

topical ketonazole

663
Q

what is the treatment for campylobacter?

A

clarithromycin if severe

664
Q

how does acute cerebellar haemorrahage present?

A

sudden-onset gait unsteadiness, vomiting and headache, followed by increasing drowsiness.

i.e. raised ICP symptoms

665
Q

A post-marketing observational study of a new drug was conducted on 5000 patients following clinical trials.

What best describes the data generated from this type of study?

A

profile of adverse effects

/ post authorisation safety study

666
Q

what is seen on renal biopsy in henoch schloin purpura?

A

mesangial deposition of IgA

667
Q

which form of gastroenteritis can often have a negative stool culture?

A

giardiasis

668
Q

what are the genetics of alpha 1 antitrypsin deficiency?

A

normal: PiMM
heterozygous: PiMZ - low risk of emphysema in non smokers
homozygous PiSS: 50% normal A1AT levels
homozygous PiZZ: 10% normal A1AT levels

669
Q

what is the first line Ix for insulinoma?

A

Measuring prolonged (72-h) fasting glucose levels is the gold standard initial test for insulinoma.

670
Q

how can you differentiate between common peroneal and L5 lesion?

A

Weakness of inversion is not seen in common peroneal nerve lesion but may be present with L5 lesion

671
Q

which antihypertensive should be used in people taking lithium?

A

CaB

ACE inhibitors, angiotensin II receptor antagonists and thiazide diuretics can all cause lithium toxicity by reducing renal lithium clearance.

672
Q

hyperacute rejection reactions are mediated by which Ab?

A

IgG

673
Q

The combination of headache, increasing drowsiness (suggesting increasing intracranial pressure), focal neurological signs and seizures in a woman shortly post partum is highly suggestive of …

A

venous sinus thrombosis.

674
Q

what are the sympotms of acute closed angle glaucoma?

A

Symptoms include headaches, eye pain, nausea, halos and reduction of visual acuity. Ciliary vessel hyperaemia is an early sign.

675
Q

which Abx cause tendon damage?

A

Tendon damage including rupture can occur rarely after use of quinolones. Quinolones are contraindicated in patients with a history of tendon disorders related to quinolone use. e.g. ciprofloxacin

676
Q

what is the PEP for needle stick of HIV patient

A

Post-exposure prophylaxis (PEP) of HIV requires a three-drug antiretroviral for 1 month

677
Q

what is Intention-to-treat method?

A

include anyone who drops out

678
Q

when is oxygen saturation by four-wavelength spectrophotometry low compared to sats/PO2?

A

CO poisoning

679
Q

what is a common cause of MI related to pregnancy?

A

coronary artery dissection

680
Q

what are the parameters of the waterlow score?

A

t uses the following parameters to risk-stratify the patient: body weight, nutritional status, continence, skin type, mobility, age and sex.

681
Q

how can we assess cvs risk with patients with renal disease/ HTN?

A

Proteinuria is an independent predictor of cardiovascular risk in patients with diabetes mellitus and/or hypertension.

682
Q

what complication is most strongly associated with H.pylori?

A

duodenal ulcer

683
Q

which Abx cause long QTc?

A

Antimicrobials that cause QT prolongation are: erythromycin, clarithromycin, moxifloxacin, fluconazole and ketoconazole.

684
Q

at what age can polymyalgia rheumatica be diagnosed?

A

> 55

685
Q

which Ab is raised in autoimmune hepatitis?

A

IgG

686
Q

what ECG change indicates posterior MI and which artery is invovled?

A

3-mm ST-segment depression in leads V1 to V3, with upright T waves and tall R waves

Circumflex

687
Q

how is cellulitis with penicillin allergy treated?

A

clindamycin

688
Q

what is Yersinia enterocolitica infection indicated in?

A

mesenteric adenitis

689
Q

what does aciclovir do to the kidneys?

A

crystaluria

690
Q

Ferritin is very high in a rare condition that causes fever, joint pain/inflammation and evanescent macular rash

A

Still’s disease

691
Q

what increases and decreases pulmonary vascular resistance?

A

It is increased by hypoxia, noradrenaline (norepinephrine) and endothelin.

decreased by epoprostenol (prostacyclin).

692
Q

what oncogene is in neuroblastoma?

A

n-myc

693
Q

which form of hodgkins carries best prognosis?

A

Hodgkin’s lymphoma - best prognosis = lymphocyte predominant

694
Q

what is the vital capacity?

A

Vital capacity - maximum volume of air that can be expired after a maximal inspiration

695
Q

how is TTP managed?

A

steroids, immunosupressants
Plasma exchange
NOT IVIG

696
Q

what is the typical presentation of methaglobinaemia?

A

SoB, headache, cyanosis
low sats, normal pO2

can be triggered by meds - co-trimoxazole, sulphonamides, dapsone

697
Q

which part of hypothalamus is invaded by craniopharygiomas?

A

ventromedial area of the hypothalamus

698
Q

which features of haemachromatosis are reversible upon treatment?

A

cardiomyopathy
skin pigmentation

other irreversible features: diabetes, liver cirrhosis, arthropathy, hypogonadism

699
Q

what are the features of neurofibromatosis type 1 and 2

A 
type 1 
Café-au-lait spots (>= 6, 15 mm in diameter)
Axillary/groin freckles
Peripheral neurofibromas
Iris hamatomas (Lisch nodules) in > 90%
Scoliosis
Pheochromocytomas

type 2
Bilateral vestibular schwannomas
Multiple intracranial schwannomas, mengiomas and ependymomas

700
Q

whatis the differece in amiodarone induced thyrotoxicosis type 1 and 2?

A

type 1 - iodine excess, goitre present, treat with carbimazole or pottasium perchlorate

type 2 - amiodarone induced destruction, no goitre, treat with steroids./

701
Q

what is the treatement for restless legs and cramping legs?

A

restless legs - ropinerole

cramping - quinine

702
Q

what is the mechanism behind heparin induced thrombocytopenia?

A

antibodies form against complexes of platelet factor 4 (PF4) and heparin

703
Q

how are early keloid scars treated?

A

early keloids may be treated with intra-lesional steroids e.g. triamcinolone

704
Q

which cause of pneumonia is associated with cold sores?

A

strept pneumonia

705
Q

how is bacterial vaginosis managed?

A

oral metronidazole

706
Q

which type of acute myeloid leukaemia carries best prognosis?

A

promyelocytic - t(15;17)

707
Q

what are the features of tuberous sclerosis?

A

depigmented ‘ash-leaf’ spots which fluoresce under UV light
roughened patches of skin over lumbar spine (Shagreen patches)
adenoma sebaceum (angiofibromas): butterfly distribution over nose
fibromata beneath nails (subungual fibromata)
café-au-lait spots

retinal hamartomas: dense white areas on retina
rhabdomyomas of the heart

MRCP (7 decks)

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