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MRCP P1 Flashcards

1
Q

What are the ECG changes associated with methadone?

A

QTc prolongation

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2
Q

What is the dabigatran reversal agent?

A

Idarucizumab

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3
Q

Which condition is Hashimoto’s thyroiditis associated with?

A

MALT lymphoma

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4
Q

How long can a patient not drive for after a cardiac angioplasty?

A

1 week

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5
Q

What is the likelihood ratio for a positive test result?

A

Sensitivity / (1 - specificity)

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6
Q

Diagnostic test for systemic mastocytosis? (2)

A

Serum tryptase

Urinary histamine

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7
Q

What are the clinical features of systemic mastocytosis? (4)

A
  • Urticaria pigmentosa + Darrier’s sign (wheels on rubbing)
  • Abdominal pain
  • flushing
  • Monocytosis on bloods
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8
Q

What is first line for shigella diarrhoea?

A

Oral ciprofloxacin (usually self limiting, only indicated if severe disease, immunocompromised or bloody diarrhoea)

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9
Q

What are the key features of Friedreich’s ataxia? (5)

A

Key features:

  • Gait ataxia (most common)
  • kyphoscoliosis (most common)
  • absent ankle jerks/down going planters
  • optic atrophy
  • spinocerebellar tract dysfunction

Other features:

  • HOCM (90%, most common cause of death)
  • Diabetes mellitus (10-20%)
  • High arched palate
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10
Q

What happens to calcium, phosphate and ALP in osteomalacia?

A

Calcium: low
Phosphate: low
ALP: high

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11
Q

Which drug reduces the effectiveness of clopidogrel?

A

Omeprazole

Clopidogrel is a substrate for Cytochrome P450 CYP2C19. CYP2C19 inhibitors include Omeprazole

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12
Q

A lesion where in the brain can cause alexia (inability to read) without agraphia (inability to write)?

A

Corpus callosum (Dejerine syndrome)

Infarction of the left posterior cerebral artery, which supplies the splenium of the corpus callosum and left occipital cortex

This condition is known as Dejerine syndrome

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13
Q

Clinical findings in complete heart block (4)

A
  • Bradycardia (30-50)
  • Wide pulse pressure
  • Cannon A waves in JVP
  • Variable intensity of S1

Symptoms may include syncope and heart failure

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14
Q

What are the non neurological associations of Friedreich’s ataxia? (3)

A

HOCM (90%, most common cause of death)
Diabetes mellitus
High arched palate

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15
Q

Management of PCOS related hirsutism? (2)

A

First line: COCP

Second line: topical eflornithine

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16
Q

Mechanism of action of rifampicin?

A

Inhibition of RNA synthesis

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17
Q

What is the target INR for patients with aortic valve replacement?

A

3.0

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18
Q

What is the target INR for patients with mitral/pulmonary/tricuspid valve replacement?

A

3.5

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19
Q

Causes of a 3rd heart sound? (3)

A
  • LV failure e.g. DCM
  • constrictive pericarditis
  • Mitral regurgitation
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20
Q

Which gene translocation is associated with Burkitt lymphoma?

A

t(8:14); c-myc gene translocation

Epstein-Barr virus (EBV) is strongly implicated in the development of the African form of Burkitt’s lymphoma and to a lesser extent the sporadic form.

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21
Q

First line antibiotic for C jejuni?

A

Clarithromycin (only in severe disease, immunocompromised and bloody diarrhoea, episode lasting more than 1 week, more than 8 stools per day)

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22
Q

Drug cause of photosensitivity? (6)

A 
tetracyclines
ciprofloxacin
Sulphonylureas
Thiazide diuretics
Amiodarone
NSAIDS
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23
Q

After hepatitis vaccination course, anti HbS >100

A

No further action, booster after 5 years

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24
Q

After hepatitis vaccination course, anti HbS 10-100

A

One further dose of vaccine, no further testing required

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25
After hepatitis vaccination course, anti HbS <10
Test for current/previous hepatitis infection + repeat full vaccination course with repeat testing following
26
Which FEV is a contraindication to lung cancer surgery?
<1.5
27
Which medication reduces the effectiveness of adenosine?
Aminophylline
28
Which medication enhances the effect of adenosine?
Dipyridamole
29
What is the mechanism of action of octreotide?
Somatostatin analogue
30
Causes of macroglossia? (3)
Acromegaly Amyloidosis Hypothyroidism
31
Causes of sleep apnoea? (4)
Obesity Macroglossia Marfan’s large adenoids
32
Most common side effect of varenicline?
Nausea
33
most common ocular manifestation of rheumatoid arthritis?
Keratoconjunctivitis sicca (dry eyes)
34
Which scale is used for the measurement of disability or dependence in activities of daily living in stroke patients?
Barthel scale
35
What should initial O2 saturations for person with known COPD be before blood gas is available?
88-92%
36
Preferred SSRI post MI
Sertraline
37
Which HLA is associated with Rheumatoid arthritis?
HLA DR4 (more specifically HLA DRB1)
38
Where can nicorandil cause GI ulceration?
Anywhere along GI tract?
39
What is the reversal agent for adrenaline induce vasoconstriction of fingers?
Local infiltration of Phentolamine (short acting alpha blocker)
40
What does a PiMZ genotype alpha-1-antitrypsin mean?
Carrier; unlikely to develop emphysema if non-smoker | PiSS and PiZZ are the homozygous genotypes, with PiZZ having the worst outcomes
41
Treatment for stronglyoides?
Ivermectin
42
Antibody positive in mixed connective tissue disease?
Anti-ribonuclear protein (anti-RNP)
43
Which translocation is associated with mantle cell lymphoma?
t(11;14)
44
What is the equation for sensitivity?
TP / (TP + FN) The proportion of patients with the condition who have a positive test result
45
Risk of vertical transmission of hepatitis C
<10%
46
Which patients should receive urate lowering therapy following an attack of gout?
Everyone!
47
What is the primary underlying mechanism of cyanide?
Inhibition of cytochrome C oxidase | leading to cessation of the mitochondrial electron chain
48
What is the most appropriate management in someone with resolved provoked AF?
Anticoagulation Consider anticoagulation if clinically appropriate (CHA2DS2VASC)
49
Mechanism of action of amphotericin B?
Binds to ergosterol (fungal cell membrane component, forming pores leading to cell wall apoptosis and fungal cell death)
50
Classic electron microscopy findings in langerhans histiocytosis?
Birbeck granules (tennis rachet shaped)
51
Number needed to treat equation?
NNT = 1 / absolute risk reduction
52
Mechanism of action of baclofen?
GABA receptor agonist
53
Inheritance of Peutz-Jegher’s syndrome?
Autosomal dominant
54
Which bacteria characteristically multiples at low temperatures?
Listeria monocytogenes
55
Treatment of clinical tetanus? (2)
IM tetanus immunoglobulin + metronidazole
56
Half life of amiodarone?
20-100 days
57
Main differential for eczema herpeticum?
Coxsackie virus
58
What is the mechanism of action of phenylephrine?
Alpha 1 agonist
59
Which chromosome are HLA on?
Chromosome 6
60
Which HLA is Behçet’s disease?
HLA B51
61
What is the most characteristic radiological feature of Ricket’s and why?
Widening of the wrist joints due to an excess of non-mineralized osteoid at the growth plate
62
Main complication of hypotonic saline (0.45% NaCl) in paediatric patients?
Hyponatraemic encephalopathy
63
Where is phosphate reabsorbed?
Proximal tubule of kidneg
64
Which artery is classically affected in lateral medullary syndrome?
Posterior inferior cerebellar artery (PICA) Cerebellar signs + contralateral sensory loss + ipsilateral Horner’s
65
Most consistent feature of PCOS?
Ovarian cysts on USS
66
Ptosis + miosis + anhidrosis affecting head arm and trunk
Central lesion e.g. stroke, syringomyelia
67
Ptosis + miosis + anhidrosis affecting head (2)
Pre-ganglionic: pancoast, cervical rib
68
Ptosis + miosis, without anhidrosis
Post ganglionic lesion - carotid artery lesions e.g. carotid artery’s aneurysm, cavernous sinus thrombosis
69
Criteria for fast tract discharge (after 2 hours symptom resolution) following anaphylaxis? (4)
– Good response to Single dose of adrenaline – complete resolution of symptoms – has been given an adrenaline auto injector and trained how to use it – adequate supervision following discharge
70
Criteria for discharge minimum six hours after symptom resolution of anaphylaxis? (2)
Two doses of Intramuscular adrenaline needed or previous biphasic reaction
71
Criteria for discharge minimum 12 hours after symptom resolution in anaphylaxis? (6)
– Severe reaction requiring more than two doses of Intramuscular adrenaline – Patient has severe asthma – possibility of an ongoing reaction e.g. slow release medication – patient presents late at night – patient in areas where access to emergency access care may be difficult – observation for at least 12 hours following symptom resolution
72
How long over should an SSRI be stopped?
Withdrawn gradually over 4 weeks | Not necessary with fluoxetine due to it’s longer half life
73
Is H pylori associated with oesophageal cancer?
No, may actually be protectivr
74
Which percentage of patients with psoriasis develop associated arthropathy?
10-20%
75
What is the equation for positive predictive value?
TP = TP + FP
76
What is the appropriate management of anticoagulation in someone who has recurrent falls?
Continue anticoagulation
77
Which intervention has the greatest effect on survival in motor neurone disease?
Non-invasive ventilation
78
Equation of power?
Power = 1 - probability of a type II error
79
Most significant side effect of aromatise inhibitors e.g. anastrozole?
Osteoporosis
80
Tonic clonic seizure + headache + numerous small focal calcification throughout both cerebral hemispheres with no enhancement?
Neurocysticercosis
81
Key features of myotonic dystrophy? (4)
Distal weakness initially Autosomal dominant Diabetes mellitus Dysarthria ``` Other features: Frontal balding Bilateral ptosis Cataracts Mild mental impairment Myotonia Testicular atrophy Heart block/cardiomyopathy Dysphagia ```
82
Low calcium following parathyroid surgery?
Hungry bone syndrome
83
Which molecule acts as a co-receptor for MHC class 1 molecules?
CD8
84
Mechanism of action of amiodarone?
Blocks voltage gated potassium channels
85
First line treatment for dysbetipoproteinaemia (remnant hyperlipidaemia)?
Fibrates
86
Treatment of serotonin syndrome?
Cyproheptadine
87
Risk factors for asystole?
Complete heart block with broad complex QRS Recent asystole Mobitz type II AV block Ventricular pass >3 seconds Even if satisfactory response to atropine, specialist help indicated to consider need for transvenous pacing
88
Which anti-TB drug needs dose adjustment in renal impairment?
Ethambutol
89
Poor prognostic factors of HOCM on echo?
Septal wall thickness >3cm
90
Which lipid disorders are associated with acute pancreatitis? (2)
Hypertriglyceridaemia Hyperchylomicronaemia NOT hypercholesterolaemia
91
Varices prophylaxis?
Propranolol
92
How to apply permethrin?
Apply to all skin including the scalp + leave for 12 hours + repeat in 7 days
93
How long does it take for an AV fistula to develop?
6-8 weeks
94
Ca-125 cancers? (2)
Ovarian | Primary peritoneal
95
Antibiotics for Strep viridians?
IV benzylpenicillin
96
First line for spasticity in MS? (2)
Baclofen | Gabapentin
97
Most common causes of infective endocarditis?
Staph aureus overall | Staph epidermidis if <2 months post valvular surgery
98
Which drug is contraindicated in VT?
Verapamil - can precipitate VF
99
Monitor respiratory function in GBS?
FVC
100
Which anti-epileptics are associated with sever cutaneous adverse reactions? (4)
phenytoin phenobarbital carbamazepine lamotrigine
101
Is amiodarone contraindicated in breast feeding??
Yes
102
Amyloidosis biopsy findings?
Congo red stain shows apple-green birefringence under polarised light
103
Treatment for aspergilloma?
Surgical resection
104
Cause of Viral meningitis + low CSF glucose?
Mumps virus
105
Which malignancies are associated as Chegwin syndrome?
Non-Hodgkins lymphoma (40 to 60 fold increased risk of lymphoid malignancy)
106
Which complement deficiency is associated with membranoproliferative glomerular nephritis secondary to partial lipodystrophy?
Complement 3
107
Which study design would require the most patients to produce a significant result?
Superiority trial (This trial compares the new treatment with a pre-existing treatment therefore would need a higher sample size to produce a significant result)
108
What ECG changes are associated with Brugada syndrome? (2)
- Convex ST segment elevation >2 mm in >1 of V1-V3 | - Partial RBBB
109
What is the biggest predictor of future thrombosis in patients with antiphospholipid syndrome?
Lupus anticoagulant
110
Type + monoclonal vs polyclonal + causes

MRCP (2 decks)

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