MRCP Geris

Question 1

Anton syndrome

Answer 1

• The patient behaves and talks as if they can see
• The patient may bump into furniture or fall over objects
• The patient may describe people and objects that aren’t there
• The patient may try to walk through walls or closed doors

Question 2

Anton syndrome secondary to

Answer 2

basilar artery infarct
bilateral occipital infarct

Note: occipital lesion hence blind but pretend they can see

Question 3

Metastatic bone marrow blood film

Answer 3

nucleated red cells
- precusor early red cell

Question 4

Polycythaemia vera diagnosis

Answer 4

JAK 2

Question 5

Pons in brainstem supplied by…

Answer 5

basilar artery

Question 6

Anterior cerebral arteries supply…

Answer 6

medial frontal lobe and superior medial parietal lobe

Question 7

MCA supplies…

Answer 7

anterior cerebral cortex
anterior temporal lobe

Question 8

posterior communicating connects…

Answer 8

PCA and internal carotid

Question 9

Myoglobinuria

Answer 9

rhabdomyolysis

Question 10

Bipolar management

Answer 10

First: lithium monotherapy
Second: vaproate with lithium

Question 11

Cranial nerves passing through jugular foramen

Answer 11

9
10
11
internal jugular vein

sx:
glossophayngeal (posterior 1/3 tongue)

Question 12

Geniculate ganglion

Answer 12

motor sensory and PSNS of facial nerve and hearing

Question 13

Internal capsule

Answer 13

motor cortex nerves cross the internal capsule
- contralateral hemiplegia

Question 14

Carotid endarterectomy for…

Answer 14

stenosis >50% if symptomatic on that side

Question 15

CLL diagnosis

Answer 15

flow cytometry for antigens on lymphocytes
aka immunophenotype

Question 16

PSP parkinson plus

Answer 16

early onset
bilateral
falls
proximal > distal rigid
dysphagia
loss of verticaal gaze

Question 17

MSA parkinson plus

Answer 17

Early postural drop
autonomic sign
coat hanger pain
sweating

Question 18

Barthel index - post stroke PROGNOSIS

Answer 18

80-100 = independent ADL
50-79 = moderate reduced
25-49 = low ADL
0-24 = v.low ADL

Question 19

Axillary nerve damage

Answer 19

deltoid patch parathesia

Question 20

CKD with OA pain management

Answer 20

topical ibuprofen
can add codeine - note risk of opioid toxicity

Question 21

Long term use to antipsychotic with involuntary movements including lip smacking

Answer 21

tardive dyskinesia

Question 22

AF with pauses of CHB

Answer 22

DDDR - dual chamber

Question 23

Pupuric rash thrombocytopenia, rash in upper arms and chest with thrombosis

Answer 23

TTP

Mx: plasma exchange with FFP

Question 24

Age related hearing loss

Answer 24

presbycusis

• bilateral sensorineural hearing loss
• dizziness

Question 25

positive rinne's

Answer 25

bone conduction better than air = sensorineural loss

Question 26

lateralisation of weber's

Answer 26

lateralise towards conductive loss lateralise away from sensory loss

Question 27

osteosclerosis

Answer 27

progressive conductive hearing loss abnormal bone growth family history

Question 28

acoustic neuroma

Answer 28

sensorineural loss facial nerve involvement

Question 29

Meniere

Answer 29

tinninus vertigo fluctuating hearing loss fullness

Question 30

VTE prophylaxis crcl 15-30

Answer 30

reduced dose clexane

Question 31

Life threatening depression stupor

Answer 31

ECT

Question 32

Lentigo maligna

Answer 32

Surgical excision

Question 33

Treatment for Waldenstrom

Answer 33

Plasmaparesis- increased viscosity

Question 34

PICA

Answer 34

lateral medullary syndrome Spinothalamic tract both face and contralateral body dysphagia slurred speech nystagmus

Question 35

Alzheimer's management mild to moderate (mmse 20-24)

Answer 35

rivastigmine

Question 36

Neostigmine use

Answer 36

myasthenia gravis

Question 37

venous ulcer

Answer 37

chronic insufficiency - haemosiderin large superficial irregular border slough in the base

Question 38

Bowmen disease

Answer 38

SCC in legs

Question 38

arterial ulcer

Answer 38

small punched out bony prominence at ankle/toe

Question 39

neuropathic ulcer

Answer 39

feet

Question 40

Delirium tremens

Answer 40

tremor sweating tachycardia agitation hallucination

Question 41

tonsillar herniation

Answer 41

Coning increase mindbrain ICP increase BP drops HR

Question 42

alpha synuclein

Answer 42

lewy body dementia

Question 43

tau protein

Answer 43

alzheimers

Question 44

beta amyloid

Answer 44

alzheimers

Question 45

prolonged QT abx

Answer 45

clarithromycin

Question 46

subacute combined degeneration of cord

Answer 46

upper and lower motor neuron B12 deficiency reduced reflex reduced motor reduced sensation- proprioception glove and stocking

Question 47

co-trimoxazole long term side effect

Answer 47

neutropenia

Question 48

Hospital acquired pneumonia organism

Answer 48

MRSA most common

Question 49

lentigo maligna

Answer 49

premalignant lesion that can become malignant melanoma

Question 50

BCC skin

Answer 50

pearly nodule with surface rolled edge telangiectasia

Question 51

SCC skin

Answer 51

arise from acintic keratosis or bowmen's disease crusted nodule ulcerated scaly

Question 52

Treatment failure for CAUTI

Answer 52

biofilm formation hence need to change catheter when infection suspected

Question 53

Frontal lobe dementia...

Answer 53

inability to draw interlocking pentagons

Question 54

Primary polycithaemia

Answer 54

neutrophil alkaline phosphatase

Question 55

nystagmus

Answer 55

cerebellum

Question 56

Prions

Answer 56

CJD- rapid dementia

Question 57

MRSA bacteramia treatment

Answer 57

first: vanc second: teic if allergic to above or linezolid

Question 58

Pick bodies

Answer 58

frontotemporal dementia

Question 59

CLL monotherapy choice

Answer 59

chlorambucil