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MRCP > MRCP P1 > Flashcards

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
Q

After hepatitis vaccination course, anti HbS <10

A

Test for current/previous hepatitis infection + repeat full vaccination course with repeat testing following

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26
Q

Which FEV is a contraindication to lung cancer surgery?

A

<1.5

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27
Q

Which medication reduces the effectiveness of adenosine?

A

Aminophylline

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28
Q

Which medication enhances the effect of adenosine?

A

Dipyridamole

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29
Q

What is the mechanism of action of octreotide?

A

Somatostatin analogue

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30
Q

Causes of macroglossia? (3)

A

Acromegaly
Amyloidosis
Hypothyroidism

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31
Q

Causes of sleep apnoea? (4)

A

Obesity
Macroglossia
Marfan’s
large adenoids

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32
Q

Most common side effect of varenicline?

A

Nausea

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33
Q

most common ocular manifestation of rheumatoid arthritis?

A

Keratoconjunctivitis sicca (dry eyes)

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34
Q

Which scale is used for the measurement of disability or dependence in activities of daily living in stroke patients?

A

Barthel scale

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35
Q

What should initial O2 saturations for person with known COPD be before blood gas is available?

A

88-92%

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36
Q

Preferred SSRI post MI

A

Sertraline

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37
Q

Which HLA is associated with Rheumatoid arthritis?

A

HLA DR4 (more specifically HLA DRB1)

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38
Q

Where can nicorandil cause GI ulceration?

A

Anywhere along GI tract?

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39
Q

What is the reversal agent for adrenaline induce vasoconstriction of fingers?

A

Local infiltration of Phentolamine (short acting alpha blocker)

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40
Q

What does a PiMZ genotype alpha-1-antitrypsin mean?

A

Carrier; unlikely to develop emphysema if non-smoker

PiSS and PiZZ are the homozygous genotypes, with PiZZ having the worst outcomes

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41
Q

Treatment for stronglyoides?

A

Ivermectin

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42
Q

Antibody positive in mixed connective tissue disease?

A

Anti-ribonuclear protein (anti-RNP)

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43
Q

Which translocation is associated with mantle cell lymphoma?

A

t(11;14)

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44
Q

What is the equation for sensitivity?

A

TP / (TP + FN)

The proportion of patients with the condition who have a positive test result

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45
Q

Risk of vertical transmission of hepatitis C

A

<10%

46
Q

Which patients should receive urate lowering therapy following an attack of gout?

A

Everyone!

47
Q

What is the primary underlying mechanism of cyanide?

A

Inhibition of cytochrome C oxidase

leading to cessation of the mitochondrial electron chain

48
Q

What is the most appropriate management in someone with resolved provoked AF?

A

Anticoagulation

Consider anticoagulation if clinically appropriate (CHA2DS2VASC)

49
Q

Mechanism of action of amphotericin B?

A

Binds to ergosterol (fungal cell membrane component, forming pores leading to cell wall apoptosis and fungal cell death)

50
Q

Classic electron microscopy findings in langerhans histiocytosis?

A

Birbeck granules (tennis rachet shaped)

51
Q

Number needed to treat equation?

A

NNT = 1 / absolute risk reduction

52
Q

Mechanism of action of baclofen?

A

GABA receptor agonist

53
Q

Inheritance of Peutz-Jegher’s syndrome?

A

Autosomal dominant

54
Q

Which bacteria characteristically multiples at low temperatures?

A

Listeria monocytogenes

55
Q

Treatment of clinical tetanus? (2)

A

IM tetanus immunoglobulin + metronidazole

56
Q

Half life of amiodarone?

A

20-100 days

57
Q

Main differential for eczema herpeticum?

A

Coxsackie virus

58
Q

What is the mechanism of action of phenylephrine?

A

Alpha 1 agonist

59
Q

Which chromosome are HLA on?

A

Chromosome 6

60
Q

Which HLA is Behçet’s disease?

A

HLA B51

61
Q

What is the most characteristic radiological feature of Ricket’s and why?

A

Widening of the wrist joints due to an excess of non-mineralized osteoid at the growth plate

62
Q

Main complication of hypotonic saline (0.45% NaCl) in paediatric patients?

A

Hyponatraemic encephalopathy

63
Q

Where is phosphate reabsorbed?

A

Proximal tubule of kidneg

64
Q

Which artery is classically affected in lateral medullary syndrome?

A

Posterior inferior cerebellar artery (PICA)

Cerebellar signs + contralateral sensory loss + ipsilateral Horner’s

65
Q

Most consistent feature of PCOS?

A

Ovarian cysts on USS

66
Q

Ptosis + miosis + anhidrosis affecting head arm and trunk

A

Central lesion e.g. stroke, syringomyelia

67
Q

Ptosis + miosis + anhidrosis affecting head (2)

A

Pre-ganglionic: pancoast, cervical rib

68
Q

Ptosis + miosis, without anhidrosis

A

Post ganglionic lesion - carotid artery lesions e.g. carotid artery’s aneurysm, cavernous sinus thrombosis

69
Q

Criteria for fast tract discharge (after 2 hours symptom resolution) following anaphylaxis? (4)

A

– 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
Q

Criteria for discharge minimum six hours after symptom resolution of anaphylaxis? (2)

A

Two doses of Intramuscular adrenaline needed or previous biphasic reaction

71
Q

Criteria for discharge minimum 12 hours after symptom resolution in anaphylaxis? (6)

A

– 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
Q

How long over should an SSRI be stopped?

A

Withdrawn gradually over 4 weeks

Not necessary with fluoxetine due to it’s longer half life

73
Q

Is H pylori associated with oesophageal cancer?

A

No, may actually be protectivr

74
Q

Which percentage of patients with psoriasis develop associated arthropathy?

A

10-20%

75
Q

What is the equation for positive predictive value?

A

TP = TP + FP

76
Q

What is the appropriate management of anticoagulation in someone who has recurrent falls?

A

Continue anticoagulation

77
Q

Which intervention has the greatest effect on survival in motor neurone disease?

A

Non-invasive ventilation

78
Q

Equation of power?

A

Power = 1 - probability of a type II error

79
Q

Most significant side effect of aromatise inhibitors e.g. anastrozole?

A

Osteoporosis

80
Q

Tonic clonic seizure + headache + numerous small focal calcification throughout both cerebral hemispheres with no enhancement?

A

Neurocysticercosis

81
Q

Key features of myotonic dystrophy? (4)

A

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
Q

Low calcium following parathyroid surgery?

A

Hungry bone syndrome

83
Q

Which molecule acts as a co-receptor for MHC class 1 molecules?

A

CD8

84
Q

Mechanism of action of amiodarone?

A

Blocks voltage gated potassium channels

85
Q

First line treatment for dysbetipoproteinaemia (remnant hyperlipidaemia)?

A

Fibrates

86
Q

Treatment of serotonin syndrome?

A

Cyproheptadine

87
Q

Risk factors for asystole?

A

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
Q

Which anti-TB drug needs dose adjustment in renal impairment?

A

Ethambutol

89
Q

Poor prognostic factors of HOCM on echo?

A

Septal wall thickness >3cm

90
Q

Which lipid disorders are associated with acute pancreatitis? (2)

A

Hypertriglyceridaemia
Hyperchylomicronaemia

NOT hypercholesterolaemia

91
Q

Varices prophylaxis?

A

Propranolol

92
Q

How to apply permethrin?

A

Apply to all skin including the scalp + leave for 12 hours + repeat in 7 days

93
Q

How long does it take for an AV fistula to develop?

A

6-8 weeks

94
Q

Ca-125 cancers? (2)

A

Ovarian

Primary peritoneal

95
Q

Antibiotics for Strep viridians?

A

IV benzylpenicillin

96
Q

First line for spasticity in MS? (2)

A

Baclofen

Gabapentin

97
Q

Most common causes of infective endocarditis?

A

Staph aureus overall

Staph epidermidis if <2 months post valvular surgery

98
Q

Which drug is contraindicated in VT?

A

Verapamil - can precipitate VF

99
Q

Monitor respiratory function in GBS?

A

FVC

100
Q

Which anti-epileptics are associated with sever cutaneous adverse reactions? (4)

A

phenytoin
phenobarbital
carbamazepine
lamotrigine

101
Q

Is amiodarone contraindicated in breast feeding??

A

Yes

102
Q

Amyloidosis biopsy findings?

A

Congo red stain shows apple-green birefringence under polarised light

103
Q

Treatment for aspergilloma?

A

Surgical resection

104
Q

Cause of Viral meningitis + low CSF glucose?

A

Mumps virus

105
Q

Which malignancies are associated as Chegwin syndrome?

A

Non-Hodgkins lymphoma (40 to 60 fold increased risk of lymphoid malignancy)

106
Q

Which complement deficiency is associated with membranoproliferative glomerular nephritis secondary to partial lipodystrophy?

A

Complement 3

107
Q

Which study design would require the most patients to produce a significant result?

A

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
Q

What ECG changes are associated with Brugada syndrome? (2)

A
  • Convex ST segment elevation >2 mm in >1 of V1-V3

- Partial RBBB

109
Q

What is the biggest predictor of future thrombosis in patients with antiphospholipid syndrome?

A

Lupus anticoagulant

110
Q

Type + monoclonal vs polyclonal + causes

A

MRCP (2 decks)

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