MRCP Deck 5 July 2023 Flashcards
Where does aqueous humour drain to?
A) Bruch’s membrane
B) Canal of Schlemm
C) Choroid plexus
D) Eustachian tube
E) Sylvian fissure
Aqueous humour flows from the ciliary body into the anterior chamber. At the front of the eye, it flows out through the trabecular meshwork and into the canal of Schlemm.
The choroid plexus produces most of the CSF of the CNS.
Which of the following is seen most frequently after TIPS?
A) Acute liver failure
B) Biliary fistula
C) Cardiac failure
D) Haemolytic anaemia
E) Hepatic encephalopathy
HE is the most common complication following TIPS placement.
Which of the following investigations is most useful to confirm a diagnosis of mumps within 36hrs of symptoms?
A) Monospot testing
B) Serum CMV IgM
C) Serum measles IgG
D) Oral fluid measles IgM
E) Oral fluid measles RNA
In early measles, detection of measles viral RNA in oral fluids is the investigation of choice. It is detected by RT-PCR and remains positive for up to 3 days after the presentation of the rash.
Oral fluid measles IgM is the most sensitive test for measles 3 days following the presentation of notes.
For a patient with HNF1-alpha MODY uncontrolled on gliclazide (HbA1c 63), what would be the next most appropriate addition?
A) Dapagliflozin
B) Long-acting insulin
C) Metformin
D) Pioglitazone
E) Sitagliptin
Long-acting insulin
Although sulfonylurea’s in MODY can be beneficial for many years, eventually B-cell failure progresses and initiation of insulin is necessary.
What is the MOA of cyclophosphamide?
A) CTLA-4 inhibition
B) DNA alkylation
C) Inhibition of IL-2 production
D) Inhibition of microtubule disassembly
E) Thymidylate synthetase inhibition
DNA alklyation
The immunosuppressive effect of cyclophosphamide is based on its inhibitory effect on B cells, CD4+ T cells and CD8+ T cells. Acrolein - a toxic metabolite, is the cause of haemorrhagic cystitis.
What is the treatment of choice in a patient recently diagnosed with Alport syndrome. His 24hr urinary protein is raised at 1.8g.
A) Amlodipine
B) Prednisolone
C) Ramipril
D) Reassurance
E) Spironolactone
ACEi are the intervention of choice to reduce proteinuria and slow renal progression in patients with Alport syndrome. Corticosteroids have no impact in slowing disease progression.
Which of the following would you expect to find on pleural fluid testing related to rheumatoid arthritis?
A) Blood staining
B) pH 7.1
C) Pleural fluid glucose 4.5mmol/L
D) Pleural LDH/serum LDH 0.4
E) Pleural fluid protein/serum protein 0.3
A pH <7.2 is a strong pointer towards a pleural effusion related to rheumatoid arthritis. Causes of a pH<7.3 include connective tissue disease, malignancy, empyema, TB and oesophageal rupture.
Pleural fluid protein/serum protein 0.3 indicates the the fluid is a transudate which is more likely to be associated with cardiac failure, liver failure and renal impairment. Elevated pleural LDH is associated with rheumatoid arthritis.
A patient present with a TIA. What is the most important contributor to risk of future stroke?
A) BP 152/92
B) Cr 132
C) T2DM
D) Duration of expressive dysphasia >80mins
E) Presence of expressive dysphasia
The events associated with the highest risk of future stroke according to the ABCD2 score are related to the duration of symptoms (>60mins) and both limb weakness and speech disturbance.
Which of the following is the biggest pointer to obesity hypoventilation syndrome?
A) BMI 37
B) Hb 140
C) Nocturnal snoring
D) Serum bicarb 32mmol/L
E) SBP 148
An elevated bicarb is associated with consistent CO2 retention and renal compensation and is a strong pointer to OHS. A serum HCO3- <27 has a 97% negative predictive value and is hence a good initial investigation before moving onto an ABG. An overnight sleep study is the best way to confirm the diagnosis, with weight loss and CPAP as optimal intervention.
What is the MOA of timolol in acute angle closure glaucoma?
A) Arteriolar constriction in the conjunctiva
B) Carbonic anhydrase inhibition
C) Constriction of the iris
D) Reduced formation of aqueous humour
E) Reduced formation of vitreous humour
B-blockers lead to a reduction in intra-ocular pressure by reducing the production of aqueous humour.
Pilocarpine is a muscarinic receptor agonist which causes constriction of the iris.
What is the treatment option for a patient with mumps orchitis?
A) Aciclovir
B) Flucloxacillin
C) Ganciclovir
D) Ibuprofen
E) Ofloxacin
Ibuprofen - supportive therapy is the intervention of choice for a mumps infection. Paracetamol an ibuprofen are particularly useful in treating the pain related to mumps orchitis.
What is the best method in controlling bone pain secondary to metastatic prostate cancer for a patient on morphine, paracetamol and ibuprofen?
A) External beam radiation therapy
B) Increased PO morphine
C) IV zoledronate
D) Strontium-89 therapy
E) Transfer to fentanyl patch
IV ibandronate and IV zoledronate are both potential options to control bone pain from metastatic prostate cancer. Denosumab can also be used.
External beam radiotherapy can be used in patients who have failed to respond to systemic therapy.
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What is most likely to happen to a patient’s INR on warfarin if they were to start taking carbamazepine?
A) Fall in INR over 3-4W
B) Fall in INR over 2-3D
C) No change in INR
D) Rise in INR over 3-4W
E) Rise in INR over 2-3D
Fall in INR over 3-4W
Carbamazepine is a potent P450 enzyme inducer. It also exhibits auto induction which builds up over a number of weeks (this leads to a need to increase the dose for treating epilepsy after 3W).
What is the most effective intervention for achalasia?
A) Amlodipine
B) Botulinum toxin
C) Isosorbide dinitrate
D) Nissen’s fundoplication
E) Pneumatic dilatation
Pneumatic dilatation is the initial treatment of choice for achalasia. Where patients fail to get benefit from dilatation, surgery (Heller’s myotomy) is the next intervention of choice.
Nissen’s fundoplication is for the management of a hiatus hernia.
What is the treatment of erysipelas near to the nose or eye?
A) PO clarithromycin
B) PO flucloxacillin
C) PO co-amoxiclav
D) PO vancomycin
E) Topical Fucidin ointment
High dose PO co-amoxiclav is the intervention of choice for erysipelas close to the nose or eye.
High dose PO flucloxacillin is recommended is erysipelas is not close to the eye or nose.
What is the most appropriate long-term management for a patient with haemachromatosis?
A) Desferrioxamine
B) Metformin
C) Penicillamine
D) Phlebotomy
E) Zinc acetate
Phlebotomy is the intervention of choice with weekly phlebotomy initially to remove 400-500ml of blood.
Desferrioxamine is a chelating agent used in the treatment of thalassemia major.
What is the MOA for clindamycin?
A) Binds to dihydrofolate reductase
B) Binds to the 50S subunit of the bacterial ribosome
C) Forms nitroso radicals to inhibit nucleic acid synthesis
D) Inhibits bacterial cell wall synthesis by attaching to specific binding proteins
E) Inhibits bacterial cell wall synthesis by binding to the D-Ala-D-Ala terminal of the growing peptide chain
Binds to the 50S subunit of the bacterial ribosome - it has bacteriostatic activity against a wide range of Gram+ve aerobes and anaerobic bacteria. It binds to the 50S subunit in a similar way to macrolides and inhibits the early stage of protein synthesis.
Which of the following cells is likely to give long-lasting immunity to hepatitis B following the vaccine?
A) APCs
B) Eosinophils
C) Macrophages
D) T cells
E) B cells
T cells are primarily responsible for immune memory and long term protection from vaccination
What is the inheritance pattern of Kallmann’s syndrome?
A) AD
B) AR
C) X-linked dominant
D) X-linked recessive
E) Y-linked
X-linked recessive
What is the most appropriate intervention for a patient with restless legs syndrome?
A) Codeine phosphate
B) Diazepam
C) Gabapentin
D) Paracetamol
E) Risperidone
Both gabapentin and pregabalin have demonstrated effectiveness in restless legs syndrome.
What is the next most appropriate intervention for a patient with dermatomyositis failing to respond to prednisolone?
A) Azathioprine
B) Ciclosporin
C) Cyclophosphamide
D) IVIG
E) Methotrexate
Azathioprine is used in patients failing to respond to prednisolone.
In patients with coexisting lung disease, such as pulmonary fibrosis, cyclophosphamide or cyclosporin may be more beneficial.
What is the MOA of baclofen?
A) Enhances aspartate release
B) Enhances dopamine release
C) GABA-A receptor agonist
D) GABA-A receptor antagonist
E) Inhibits glutamate release
Baclofen is a GABA-B agonist which causes inhibition of glutamate and aspartate.
Which of the following is the main treatment for ethylene glycol (anti-freeze) poisoning?
A) Activated charcoal via NGT
B) Ethyl alcohol
C) Fomepizol
D) Naloxone
E) Sodium bicarbonate
Fomepizol is the main treatment for ethylene glycol poisoning - it is a competitive inhibitor of alcohol dehydrogenase to block the formation of toxic metabolites of ethylene glycol.