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MRCP PART 1 > MRCP OFFICIAL PAPER > Flashcards

MRCP OFFICIAL PAPER Flashcards

1
Q

What glomerular abnormality is seen in IgA vasculitis (HSP)?

A

Rash (non blanching)
Arthritis
Acute glomerulonephritis

  • Mesangial deposition of IgA
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2
Q

In which condition is foot process effacement seen on renal biopsy?

A

Nephrotic syndrome.

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3
Q

In which condition is linear deposition of IgG on basement membrane seen on renal biopsy?

A

Anti-glomerular basement membrane disease.

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4
Q

In which condition is thickening of basement membranes seen on renal biopsy?

A

Alport Syndrome.

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5
Q

Hepatitis B serology in patient with previous immunisation to hep B?

A

positive anti-hepatitis B surface antibody but all others negative.

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6
Q

Antibody for antiphospholipid syndrome?

A

Anticardiolipin antibodies.

The livedo reticularis, cognition problems and loin pain are a result of thrombosis.

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7
Q

1-month history of weight loss, abdominal distension, flatulence and foul-smelling diarrhoea following a visit to India?

A

Giardiasis

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8
Q

Laboratory finding in Wilson’s disease?

A
  1. Low serum caeruloplasmin concentration.
  2. Free (non-ceruloplasmin-bound) serum copper is increased.
  3. Increased urinary copper excretion
  4. Reduced total serum copper (counter-intuitive, but 95% of plasma copper is carried by ceruloplasmin).

Levels of caeruloplasmin are low in most cases. Hepatic, serum and urinary copper levels are all elevated. Caeruloplasmin is the molecule by which about 95% of copper is normally carried.

Wilson’s disease is an autosomal recessive disorder characterised by excessive copper deposition.
commonly presents with hepatic, neurological and psychiatric signs and symptoms.

Kayser-Fleischer rings.

Mx Penicillamine.

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9
Q

Lactose is broken down into what by lactase?

A

Glucose + Galactose

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10
Q

Sucrose is broken down into what by Sucrase?

A

Glucose + Fructose

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11
Q

Maltose is broken down into what by maltase?

A

Glucose + Glucose

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12
Q

16-year-old girl presented with non-scaly, discrete areas of hair loss on the scalp. She had a history of atopic eczema and had a number of depigmented areas on her hands and around her eyes.

What is the most likely diagnosis?

A

Alopecia Areata.
Alopecia areata is an immunologically based disorder where there are discrete areas of hair loss but WITHOUT scarring or scaling, and patients with this condition have a higher incidence of atopic eczema.

Lupus erythematosus - there is usually active inflammation with scarring
Trichotillomania - there are residual short hairs at the affected site, because the patient generally finds it difficult to pull newly growing hairs.

Seborrhoeic dermatitis generally gives diffuse scaling on the scalp without hair loss; although it can cause some areas of hair loss, this would be associated with scaling of the scalp.

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13
Q

Features of Adie’s tonic pupil?

A

Holmes-Adie pupil is a benign condition most commonly seen in women. It is one of the differentials of a dilated pupil.

  • Unilateral
  • DILATED pupil
  • Once the pupil has constricted it remains small for an abnormally long time
  • Slowly reactive to accommodation
  • Does NOT react to light (very poorly)

Holmes-Adie syndrome:
association of Adie’s tonic pupil with absent ankle/knee reflexes

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14
Q

Features of afferent pupillary defect?

A

An afferent pupillary defect is due to impaired ipsilateral optic nerve function, causing brief paradoxical pupillary dilatation to light with the “swinging torch” test

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15
Q

Features of Argyll Robertson pupils?

A

Argyll Robertson pupils accommodate but do not react and are typically bilaterally SMALL.

a.k.a prostitute pupil:
They both “accommodate, but don’t react“, and both are associated with neurosyphilis.

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16
Q

Features of third nerve palsy?

A
  1. Eye is deviated down and out
  2. Ptosis
  3. Dilated pupil (mydriasis)
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17
Q

Mx for recurrent renal stone?

A

Urinary citrate reduces urinary supersaturation of calcium salts by forming soluble complexes with calcium ions, and by inhibiting crystal growth and aggregation, hence the use of potassium citrate in recurrent stone formation.

Calcium stones may be due to hypercalciuria - thiazides diuretics (increase distal tubular calcium resorption).

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18
Q

Prevention for oxalate stones?

A

Cholestyramine and Pyridoxine reduces urinary oxalate secretion.

Low-calcium diets lead to increased oxalate absorption production, which is counterproductive.

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19
Q

Most common thrombophilia condition?

A

Factor V Leiden (activated protein C resistance) is the most common inherited thrombophilia.

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20
Q

Most common bleeding disorder?

A

Von Willebrand’s disease is the most common inherited bleeding disorder. The majority of cases are inherited in an autosomal dominant fashion and characteristically behaves like a platelet disorder i.e. epistaxis, bleeding after dental extraction and menorrhagia are common whilst haemoarthroses and muscle haematomas are rare.

Prolonged bleeding time
APTT may be prolonged

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21
Q

Alpha-1 antitrypsin deficiency phenotype?

A

Patients who manifest disease usually have ZZ genotype.

The S genotype is an intermediate deficiency and M is normal, Z is severe.

normal: MM
heterozygous: MZ
homozygous SS: 50% normal A1AT levels
homozygous ZZ: 10% normal A1AT levels

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22
Q

Most common thyroid cancer?

A

Papillary carcinoma.
Often young females - excellent prognosis.

Mx:
- Total thyroidectomy
followed by radioiodine (I-131) to kill residual cells

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23
Q

Feature of follicular adenoma?

A

Usually present as a solitary thyroid nodule.

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24
Q

Features of medullary carcinoma?

A

Cancer of parafollicular (C) cells

  1. Serum Calcitonin levels are raised. (Calcitonin lowers blood calcium levels by suppressing osteoclast activity)
  2. Part of MEN-2
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25
Q

Features of anaplastic thyroid carcinoma?

A
  • Most common in elderly females
  • Local invasion is a common feature.
  • Causes pressure symptoms.
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26
Q

Bone pain with normal calcium, phosphate and raised ALP?

A

Paget’s disease.

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27
Q

Blood results in osteomalacia?

A
  • Low vitamin D levels
  • Low calcium
  • Low phosphate
  • Raised ALP
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28
Q

How does allopurinol precipitate acute gout?

A

Urate-lowering therapy commonly leads to acute flares of gout, thought due to falling serum urate levels leading to uric acid crystals detaching from articular cartilage. It’s good practice to offer prophylaxis with NSAID or colchicine for the first 6 months of allopurinol therapy.

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29
Q

Gene abnormality in Burkitt’s lymphoma?

A

Burkitt’s lymphoma is associated with the C-Myc gene overexpression. Chromosome 8 and 14.

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30
Q

JAK2 mutation associated with which condition?

A

JAK2 mutations are associated typically with myeloproliferative disease in particular primary polycythaemia.

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31
Q

Which condition associated with BCR-ABL gene?

A

BCR-ABL is associated with chronic myeloid leukaemia.

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32
Q

When to give pneumococcal vaccine prior to splenectomy?

A

1 month before splenectomy.

  • Hib, meningitis A & C
  • annual influenza vaccination
  • pneumococcal vaccine every 5 years
33
Q

MODY features?

A

MODY usually do not present with diabetic ketoacidosis except under severe stress conditions, and unlike Type 2 diabetes, they are often of normal weight and do not exhibit signs of insulin resistance.

They usually have strong FH of diabetes. Autosomal dominant inheritance pattern.

34
Q

In severe haemoptysis requiring treatment, the source of bleeding is which artery?

A

Bronchial and pulmonary arteries in 90% and 5% of cases.

35
Q

Feature of pityriasis rosea?

A
  • A minority may give a history of a recent viral infection.
  • Herald patch (usually on trunk)
    followed by erythematous, oval, scaly patches which follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a ‘fir-tree’ appearance.
  • Self limiting.
36
Q

Acute tubular necrosis vs tubulointerstitial nephritis?

A

There are two main causes of ATN; ischaemia and nephrotoxins:
- Ischaemia, shock, sepsis
nephrotoxins:
- aminoglycosides
- myoglobin secondary to rhabdomyolysis
- radiocontrast agents
- lead

Acute tubular necrosis is classically associated with a bland urinalysis.

Acute interstitial nephritis accounts for 25% of drug-induced acute kidney injury.

Causes:
- Drugs: the most common cause, particularly antibiotics.
- Penicillin
- Rifampicin
- NSAIDs
- Allopurinol
- Furosemide
- systemic disease: SLE, sarcoidosis, and Sjögren’s syndrome
infection: Hanta virus , staphylococci

37
Q

Gold standard Ix for diagnosis of insulinoma?

A

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

  • Features of hypoglycaemia: typically early in morning or just before meal, e.g. diplopia, weakness etc
  • Episodic sweating and hunger
  • Rapid weight gain may be seen
38
Q

Patient with Crohn’s presenting with diarrhoea with previous history of terminal ileum resection?

A

Bile salt induced diarrhoea.

39
Q

Drug most likely to restore sinus rhythm in young patient with acute onset AF?

A

Flecainide (avoid using the drug in patients with left ventricular dysfunction or ischaemic heart disease as it is negatively inotropic).

  • amiodarone if structural heart disease, flecainide or amiodarone in those without structural heart disease.
40
Q

Multiple, violaceous, flat-topped papules over the flexor surfaces of the wrists, and on the ankles and lower back. The papules were aggregated in a linear fashion at one site on her left forearm?

A

Lichen planus causes violaceous, flat-topped papules, which are often seen on the flexor surfaces of the wrists, lower back and ankles as well as elsewhere on the skin. Lichen planus can koebnerise, which is when the lesions arise at an area of skin that has been traumatised, and the linear pattern on left forearm would be consistent with koebnerisation from scratching. Lichen planus frequently causes a lacy, white pattern on the buccal mucosa - Oral Lichen Planus.

Potent topical steroids are the mainstay of treatment

41
Q

CXR finding of aspergilloma?

A

An aspergilloma is a mycetoma (mass-like fungus ball) which often colonises an existing lung cavity (e.g. secondary to tuberculosis, lung cancer or cystic fibrosis).

Chest x-ray containing a rounded opacity. A crescent sign may be present.
- High titres Aspergillus precipitins

42
Q

Effects seen when taking cocaine?

A

Cocaine is a sympathomimetic drug that causes chest pain, hypertension, agitation and arrhythmias.

Hyperthermia and rhabdomyolysis are recognised complications resulting from its serotoninergic effects.

43
Q

Ix for venous ulcer?

A

Venous ulceration is typically seen above the medial malleolus.

ankle-brachial pressure index (ABPI) is important in non-healing ulcers to assess for poor arterial flow which could impair healing.

Treatment for venous ulceration is with a compression bandage, However, compression is contraindicated if there is insufficient arterial supply to the foot, because, in that case, the compression could lead to lower limb ischaemia, so it is important to check blood flow into the leg before prescribing compression bandages.

44
Q

A 50-year-old woman presented with a 6-month history of diarrhoea and weight loss of 5 kg. She described her stools as pale and bulky. She had a history of Raynaud’s phenomenon.

On examination, the skin over her fingers was shiny and tight.

What is the most likely cause of her diarrhoea?

A

Risk factors for SBBOS:
- neonates with congenital gastrointestinal abnormalities
- scleroderma
- diabetes mellitus

She has developed small intestinal bacterial overgrowth, which is a common complication in systemic sclerosis. Systemic sclerosis affects the small intestine, causing reduced peristalsis and small bowel dilatation, resulting in alterations in the small bowel bacterial flora. Features include loose stools, steatorrhoea, malabsorption, abdominal discomfort and flatulence.

45
Q

What pulmonary function test result would be most characteristic of a diagnosis of idiopathic pulmonary fibrosis?

A

The transfer factor describes the rate at which a gas will diffuse from alveoli into blood. Carbon monoxide is used to test the rate of diffusion.

Transfer factor for CO is used to determine the severity of the fibrosis and can be used to monitor progression of disease.

46
Q

MOA of clopidogrel?

A

It inhibits binding of adenosine diphosphate. Clopidogrel irreversibly inhibits platelet aggregation via P2Y12 class ADP receptors.

47
Q

MOA of aspirin?

A

Aspirin inhibits production of thromboxane A2 through COX-1 inhibition.

48
Q

Mode of inheritance of Osler-weber-rendu syndrome?

A

Autosomal dominant.

hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant condition characterised by (as the name suggests) multiple telangiectasia over the skin and mucous membranes.

  1. Epistaxis : spontaneous, recurrent nosebleeds
  2. Telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)
  3. Visceral lesions: for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM.
49
Q

Initial haemodynamic response in valsalva maneouvre?

A

JVP will increase initially and cardiac output drops.

50
Q

Most appropriate anti hypertensive in a patient taking lithium?

A

Amlodipine is the preferred choice as it does not cause a significant increase in serum lithium concentration. ACEi, ARBs and thiazide diuretics can all cause lithium toxicity by reducing renal lithium clearance.

51
Q

Number needed to treat formula?

A

It is calculated by 1/(Absolute risk reduction) and is rounded to the next highest whole number.

Experimental event rate (EER) = (Number who had particular outcome with the intervention) / (Total number who had the intervention)

Control event rate (CER) = (Number who had a particular outcome with the control/ (Total number who had the control)

52
Q

Tx for Amitryptiline overdose?

A

Treatment of complications of tricyclic poisoning (hypotension and arrhythmias) consists of correction of metabolic acidosis with sodium bicarbonate.

53
Q

Immunoglobulin for hyperacute rejection?

A

Hyperacute rejection occurs because of pre-existing humoral immunity, which is IgG mediated.

54
Q

Mx for restless leg syndrome?

A

The dopamine agonists ropinirole, pramipexole and rotigotine may be used for the treatment of moderate to severe restless legs syndrome.

55
Q

Head injury with lucid interval?

A

Extradural haematoma.

On imaging, an extradural haematoma appears as a biconvex hyperdense collection around the surface of the brain. They are limited by the suture lines of the skull.

56
Q

A 55-year-old woman presented with a 2-day history of diplopia and progressive gait unsteadiness.

On examination, she had limited eye movements in all directions and her pupils were poorly reacting. Muscle power in the limbs was normal but tendon reflexes were absent. There was prominent bilateral finger–nose ataxia. Plantar responses were flexor. Sensation was normal.

What is the most likely diagnosis?

A

Miller Fisher syndrome is the triad of ataxia, internal and external ophthalmoplegia and areflexia.

57
Q

What autoantibody is most strongly associated with an increased risk of congenital heart block in the fetus?

A

Both anti-Ro and anti-La antibodies can be involved but it is more common with anti-Ro antibodies. Both antibodies are associated with neonatal lupus.

58
Q

Microscopic appearance of pseudogout (calcium pyrophosphate) crystals?

A

Calcium pyrophosphate crystals cause pseudogout, and are seen on microscopy as positively birefringent rhomboid crystals.

59
Q

Microscopic appearance of gout crystals?

A

Gout crystals are needle-shaped with negative birefringence.

60
Q

Which organism is infective endocarditis associated with colorectal carcinoma?

A

Streptococcus gallolyticus (S. bovis) endocarditis is classically associated with colonic carcinoma and adenoma, and also with chronic liver disease.

Staphylococcus aureus is an increasingly common cause of endocarditis, often seen in patients with early endocarditis following heart valve surgery, as well as in patients with a history of intravenous drug use, or with indwelling cannulae such as dialysis lines.

Coagulase-negative streptococcal endocarditis is the commonest cause of native valve endocarditis.

61
Q

Causative organism in cat scratch fever?

A

Cat scratch disease is generally caused by the Gram negative rod Bartonella henselae.

62
Q

A 66-year-old man, who was undergoing maintenance haemodialysis through a subcutaneous tunnelled catheter, presented with fever, chills and rigors during haemodialysis.

Most common organism associated?

A

Staphylococcus epidermidis or coagulase-negative staphylococcal infections are common infections with vascular dialysis catheters.

63
Q

Which condition is most likely to be precipitated by the use of ciprofloxacin?

A

Tendon damage including rupture can occur rarely after use of quinolones.

64
Q

Investigation for Acromegaly?

A

Growth hormone suppression test.

Failure of growth hormone levels to be suppressed on a growth hormone suppression test indicates excess production.

65
Q

First rank symptoms of Schizophrenia?

A

Schneider’s first rank symptoms may be divided into auditory hallucinations, thought disorders, passivity phenomena and delusional perceptions.

66
Q

A 56-year-old man presented with double vision

On examination, he had bilateral partial ptosis, diplopia and truncal muscle weakness.

CXR- widened mediastinum

A

Myasthenia gravis and the widened mediastinum would be consistent with thymoma.

67
Q

MOA of thiazide diuretics?

A

Thiazide diuretics act on the distal tubule by blocking the thiazide-sensitive Na+-Cl− symporter.

68
Q

A 25-year-old injecting drug user presented with an injection-site abscess.

On examination, his temperature was 38.5°C and there was a pansystolic murmur.

What organism is most likely to be cultured from both the abscess and the blood?

A

Staph aureus.

69
Q

Post exposure prophylaxis for HIV following needle stick injury?

A

Three-drug antiretroviral treatment for 1 month.

70
Q

Mx for pregnant patient exposed to varicella zoster?

A

If there is any doubt about the mother previously having chickenpox maternal blood should be urgently checked for varicella antibodies.

if the pregnant woman <= 20 weeks gestation is not immune to varicella she should be given varicella-zoster immunoglobulin (VZIG) as soon as possible.

if the pregnant woman > 20 weeks gestation is not immune to varicella then either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure.

71
Q

Post exposure prophylaxis for someone exposed to hepatitis B example through needle stick injury?

A

HBsAg positive source:
- If the person exposed is a known responder to the HBV vaccine then a booster dose should be given.

  • If they are a non-responder (anti-HBs < 10mIU/ml 1-2 months post-immunisation) they need to have hepatitis B immune globulin (HBIG) and a booster vaccine.
72
Q

Most common cause of viral gastroenteritis?

A

Norovirus is the most common cause of viral gastroenteritis. It is transmitted by faecally contaminated food or water, by person-to-person contact, and via aerosolisation of vomited virus and subsequent contamination of surfaces. Outbreaks in cruise ships are common.

Rotavirus is most common in children.

73
Q

Ix for suspected occupational asthma?

A

The presentation suggests occupational asthma. Serial peak flow measurements would be helpful in determining that his symptoms are worse at work with corresponding drop in the peak flow.

74
Q

Symptoms in parietal lobe infarct?

A

Dominant parietal lobe lesions can cause a variety of problems including receptive dysphasia, dyslexia, inattention and sensory impairments, finger agnosia, acalculia, agraphia and left–right limb disorientation.

75
Q

What is the normal function of BRCA1?

A

BRCA1 is a tumour suppressor gene, coding a DNA repair protein.

76
Q

A 46-year-old man presented within 1 hour of ingesting 40 tablets of slow-release theophylline.
What is the most appropriate initial management?

A

Activated charcoal given within 1 hour adsorbs theophylline and reduces its absorption. Multiple doses of activated charcoal may also be given to enhance the elimination of theophylline.

77
Q

What is the most common physical finding seen in constrictive pericarditis?

A

Hepatomegaly is the earliest and most consistent feature of pericardial constriction.

78
Q

56 year old woman with deranged LFTs.

serum alanine aminotransferase 65 U/L (5–35)
serum aspartate aminotransferase 75 U/L (1–31)
serum alkaline phosphatase 305 U/L (45–105)
serum gamma glutamyl transferase 150 U/L (4–35)

Ix?

A

Antimitochondrial antibodies are present in over 90% of patients with primary biliary cholangitis (PBC). The pattern of deranged liver function tests is cholestatic and likely indicates PBC.

Biliary obstruction is characterized by elevated levels of ALP, typically three times the normal level. Disproportionate elevation in ALP compared to ALT and AST.

79
Q

What structure is implicated in the pathophysiology of lipodermatosclerosis?

A

Hypodermis.

MRCP PART 1 (20 decks)

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