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mrcp part 1 Flashcards

1
Q

quinolones mechanism of action

A

inhibit topoisomerase II (DNA gyrase) and topoisomerase IV

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2
Q

most common cause of viral meningitis

A

human enteroviruses- coxsackievirus/ echovirus

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3
Q

specificity

A

people who DO NOT have the disease and test NEGATIVE

TN/ (TN + FP)

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4
Q

sensitivity

A

people who HAVE the disease and test POSITIVE

TP/ (TP + FN)

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5
Q

mechanism of action of cisplatin

A

can cause cross linking in DNA

( CC- Ciplatin= Crosslinking)

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5
Q

Mechanism of action of vincristine

A

inhibits microtubules formation

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6
Q

positive predictive value

A

the chance the person has the disease if the test is positive

PPV= TP/ (TP +FP)

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7
Q

negative predictive value

A

the chance the person DOES NOT have the disease if the test is NEGATIVE

NPV= TN/ (TN + FN)

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8
Q

Burkitts lymphoma gene

A

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

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9
Q

receptor for EBV

A

CD21

(21 year olds can get EBV)

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10
Q

treatment for widened QRS in tricyclic overdose

A

IV sodium bicarb

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11
Q

Loffler’s syndrome

A

Transient respiratory illness (fever, cough, night sweats) causing blood eosinophilia and CXR shadowing.

Can be caused by parasites

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12
Q

Treatment for acute eosinophilic pneumonia

A

highly responsive to steroids

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13
Q

secondary messenger system stimulated by NO

A

cGMP

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14
Q

Action of proteasome

A

Degredation of polypeptides through breaking polypeptide bonds

Found in nucleus and cytoplasm

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15
Q

Von Hippel-Lindau method of inheritence and location of gene

A

Autosomal dominant
VHL gene on chromosome 3 (VHL=3letters= chromosome 3)

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16
Q

Von Hippel-Lindau associated tumours

A

cerebellar haemangiomas–> subarachnoid haemorrhages
retinal haemangiomas–> vitreous haemorrhage
renal cysts (premalignant)
phaeochromocytoma
extra-renal cysts: epididymal, pancreatic, hepatic
endolymphatic sac tumours
clear-cell renal cell carcinoma

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17
Q

Cancer associated with Hashimotos

A

MALT tumours

can present without typical B featuresf

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18
Q

CLL treatment regime

A

FCR
Fludarabine cyclophosphamide rituximab

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19
Q

Non Hodgkins lymphoma treatment

A

RCHOP
Rituximab doxorubicin cyclophosphamide vincristine

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20
Q

Gene defect in AIP Acute intermittent Porphyria

A

Porphobilinogen deaminase

Aip- porphobilinogen deAminase

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21
Q

Gene defect in PCT porphyria cutanea tarda

A

uroporphinogen decarboxylase

pCt= uroporphinogen deCarboxylase

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22
Q

investigation for betathalasaemia trait

A

haemoglobin electrophoresis

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23
Q

causes of upper zone fibrosis

A

C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis

Think up in the charts

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24
Q

cause of soft S2

A

aortic stenosis

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25
Q

LBBB heart sound

A

reversed (left) split S2

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26
Q

RBBB heart sound

A

widely split (right) S2

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27
Q

cause of loud S2

A

hypertension

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28
Q

widely split S2 causes

A

RBBB
pulmonary stenosis
severe mitral regurg
deep inspiration

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29
Q

reverse split S2 causes

A

LBBB
patent ductus arteriosus
R ventricular pacing
severe AS
WPW syndrome type B

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30
Q

syphillis serology
Positive non-treponemal test and positive treponemal test

A

active syphillis infection

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31
Q

syphillis serology
Positive non-treponemal test + negative treponemal test

A

false positive

(e.g. SLE, RA, malaria, HIV, antiphospholipid syndrome, TB, leprosy)

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32
Q

syphillis serology
Negative non-treponemal test + positive treponemal test

A

previously treated syphillis

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33
Q

Fabry’s disease

A

X linked disorder
deficiency in alpha galactosidase–> causes progressive lysosomal depositiion of Gb3 in various tissues causing multiorgan dysfunction

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34
Q

Budd Chiari symtoms

A

ascites, abdominal pain, and hepatomegaly

(thrombosis of the hepatic vein)

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35
Q

when to suspect a diagnosis of MODY

A

individuals with persistent, asymptomatic hyperglycemia detected before the age of 25, without the typical features of Type 1 or Type 2 diabetes

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36
Q

MODY 2 treatment

A

no specific treatment required

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37
Q

MODY 3 treatment

A

low dose sulphonylurea

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38
Q

cyclosporin side effects

A

nephrotoxicity and hepatotoxicity
fluid retention
hypertension
hyperkalaemia
hypertrichosis
gingival hyperplasia
tremor
impaired glucose tolerance and hyperlipidaemia
increased susceptibility to severe infection

(everything is increased)

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39
Q

symptoms of Pendred’s disease

A

autosomal recessive disorder found on chromosome 7 causing a defect in the organification of iodine

bilateral sensorineural deafness
mild hypothyroid
goitre

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40
Q

causes of normal ion gap acidosis

A

ABCD

Addisons
Bicarb loss (diarrhoea or renal tubular acidosis)
Chloride excess
Diuretics

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41
Q

causes of high ion gap acidosis

A

lactate- sepsis
Ketones- DKA
renal failure
toxins

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42
Q

main constituent of pulmonary surfactant

A

phospholipids, proteins and carbohydrates- dipalmitoyl phosphatidylcholine

=DPPC

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43
Q

treatment of magnesium sulphate induced respiratory depression

A

calcium gluconate

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44
Q

What are Forrest plots/ blobbograms used for?

A

Blobbograms are used to display the results of all the constituent studies included in a meta-analysis.

Conventionally, each study is represented with a data point showing the odds ratio (e.g. of death in placebo vs control) with error bars representing a 95% confidence interval.

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45
Q

What are funnel plots used to show?

A

Publication bias in meta-analyses

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46
Q

What are box plots used for

A

Used to show quantitative results

Can show the means and range etc as well as positive or negative skew

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47
Q

What does a histogram show

A

Type of bar chart that shows how many times a variable occurs within a set range.

e.g. the number of myocardial infarctions on the y-axis against patient age by decade on the x-axis

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48
Q

what does a symmetrical inverted funnel plot indicate?

A

publication bias is unlikely

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49
Q

Which class of antibodies mediate hyperacute organ rejection

A

IgG

pre-exsiting IgG antibodies against HLA antigens

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50
Q

3 reasons for hypertension in patients with neurofibromatosis

A

essential hypertension
phaeochromocytoma
renal vascular stenosis from fibromusculardysplasia

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51
Q

causative organism for bilateral pneumonia with cavitating lung lesions following a viral illness?

A

staph aureus

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52
Q

which type of bacteria is listeria

A

gram positive bacillus

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53
Q

therapy indicated for heart failure patients with a LVEF < 35% who are still symptomatic on ACE-inhibitors & beta-blockers

A

sacubitril-valsartan

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54
Q

therapy for adrenaline induced ischaemia

A

phentolamine

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55
Q

drugs which may cause an acute attack of AIP

A

barbiturates
halothane
benzodiazepines
alcohol
oral contraceptive pill
sulphonamides

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56
Q

diagnostic criteria for patients with suspected COPD

A

FEV1/FVC less than 70% predicted and symptoms suggestive of COPD

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57
Q

treatment for facial hirsutism

A

topical eflornithine

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58
Q

Treatment for GuillianBarre Syndrome

A

IV IG

(helps neutralise the antibodies which cause GBS)

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59
Q

severe hypokalaemia ECG changes

A

U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT

(U have no Pot and no T but a long PR and a long QT)

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60
Q

Holmes Adie pupil

A

once the pupil has constricted it remains small for an abnormally long time

slowly reactive to accommodation but very poorly (if at all) to light

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61
Q

McArdles disease symptoms

A

muscle pain and stiffness following exercise
muscle cramps
myoglobinuria
low lactate levels during exercise

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62
Q

test used to investigate hypopituitarism

A

insulin stress test

Give IV insulin and measure GH and cortisol

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63
Q

spinal cord compression above level of L1 symptoms

A

upper motor neuron signs and a sensory level

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64
Q

spinal cord compression below the level of L1 symptoms

A

lower motor nueron signs
increased tendon reflexes above the lesion
absent tendon reflexes at the lesion

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65
Q

diagnostic criteria for allergic bronchopulmonary aspergillosis

A

Major criteria for the diagnosis are:
Clinical features of asthma
Proximal bronchiectasis
Blood eosinophilia
Immediate skin reactivity to Aspergillus antigen
Increased serum IgE (>1000 IU/ml)

Minor criteria:
Fungal elements in sputum
Brown flecks in sputum
Delayed skin reactivity to fungal antigens

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66
Q

management for allergic bronchopulmonary aspergillosis

A

glucocorticoids

itraconazole is second line

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67
Q

indicators for severe pancreatitis

A

hypocalcaemia
hyperglycaemia
age over 55
hypoxia
elevated LDH and AST
neutrophilia

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68
Q

treatment of thyroid dysfunction for a patient recently started on amiodarone

A

continue amiodarone and give thyroid replacement

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69
Q

first line treatment for myoclonic seizures in males

A

sodium valporate

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70
Q

drugs which may exacerbate myasthenia gravis

A

penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines

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71
Q

Miller Fisher syndrome antibodies

A

Anti-GQ1b

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72
Q

Myasthenia gravis antibodies

A

Anti-MuSK
Anti-AChR

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73
Q

Eaton Labert Syndrome antibodies

A

Anti-VGCC

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74
Q

VIP action

A

stimulates secretion from pancreas and intestines

inhibits gastric acid secretion

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75
Q

Gene mutation associated with CADSIL

A

NOTCH3 mutation

(CADSIL= cerebral autosomal dominant arteriopathy with subcortical infarcts and leukencephalopathy)

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76
Q

Fabry disease gene mutation

A

GLA mutation

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77
Q

Examples of anthracyclines

A

doxorubicin and epirubicin

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78
Q

most common histological finding in rheumatic heart disease

A

Ashcoff bodies

(granulomatous bodies found in rheumatic heart fever)

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79
Q

antiphospholipid syndrome clotting screen findings

A

prolonged APTT
low platelets

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80
Q

Leishmaniasis treatment

A

miltefosine

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81
Q

mechanism of renal protective use of ACEi

A

dilation of EFFERENT arteriole

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82
Q

Cancer associated with schistosomiasis infection

A

Squamous cell bladder cancer

Schisto= Squamous

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83
Q

Histological finding associated with gastric adenocarcinoma

A

Signet cells

(large mucin containing vacuole pushes the nucelus to one side, giving the appearance of a Signet ring)

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84
Q

plan for patients admitted with MI on metformin treatment

A

stop metformin as can cause lactic acidois

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85
Q

around 1 in 10 people diagnosed with renal angiomyolipomas are diagnosed with which condition?

A

tuberous sclerosis

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86
Q

action of maltase

A

breaks down maltose into 2 glucose

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87
Q

action of sucrase

A

breaks down sucrose into glucose and fructose

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88
Q

action of lactase

A

breaks down lactose into glucose and galactose

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89
Q

which type of vaccine is yellow fever

A

live attenuated

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90
Q

gentamicin is nephrotoxic as it causes what?

A

acute tubular necrosis

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91
Q

mercury poisoning symptoms

A

visual field defects, paraesthesias and hearing loss

can also cause hyperchloraemic metabolic acidosis

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92
Q

features of cholesterol emboli

A

renal failure
livedo reticularis
eosinophilila
purpura

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92
Q

which layer are melanocytes found in?

A

stratum germinativum

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92
Q

biochemical features associated with anorexia nervosa

A

HIGH Cs AND Gs

high cholesterol
high cortisol
carotinaemia

high glucose
high GH
high salivary Gland output

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92
Q

Dengue symptoms

A

fever
retro orbital headache
facial flushing
rash

bitten by mosquitos/returning traveller

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93
Q

fever
retro orbital headache
rash
thrombocytopenia
facial flushing

A

dengue

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93
Q

Dengue treatment

A

’
Ipportive with fluids etc

(no anti retrovirals indicated)

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94
Q

Dengue investigations

A

Bloods- thrombocytopenia, leukopenia, raised liver enzymes

NAATS for viral RNA
NS1 antigen

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95
Q

testicular seminoma tumour marker

A

HCG

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96
Q

pemphigus vulgaris- antibody is directed against what?

A

desmoglein
(components of desmosomes)

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97
Q

normal distribution

A

mean=mode=median
68% of values under the curve lie within 1 standard deviation of the mean

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97
Q

systemic mastocytosis symptoms

A

urticaria pigmentosa (wheals on rubbing)
flushing
abdo pain
mastocytosis on blood film

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98
Q

best imaging modality for osteomyelitis

A

MRI

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99
Q

most common bacterial cause of osteomyelitis in patients with sickle cell disease

A

salmonella

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100
Q

Mantle cell lymphoma gene translocation

A

t(11:15)

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101
Q

Burkitt’s lymphoma histology

A

‘starry sky’

lymphocytes sheets with interspersed macrophages containing dead apoptotic tumour cells

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102
Q

presents with
flu like illness less than 1 week–> brief period of remission –> jaundice and haematemesis

A

Yellow fever

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103
Q

NICE target after starting statin for 3 months

A

40% reduction in non-HDL 40% cholesterol in 3 months

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104
Q

oseltamivir/ tamiflu mechanism of action

A

neuraminidase inhibitor

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105
Q

mechanism of hypercalcaemia in sarcoidosis

A

Macrophages in the granulomas cause increased conversion of Vit D to it’s active form

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106
Q

most important blood test for restless legs syndrome

A

ferritin

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107
Q

mechanism of action of NAC

A

replenishes glutathione

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Perfectly
108
Q

which cancer is most associated with ectopic ACTH production

A

small cell lung cancer

109
Q

treatment for C diff which does NOT respond to oral vancomycin or fidaxomicin?

A

oral vancomycin and IV metronidazole

110
Q

tumour marker associated with primary peritoneal cancer

111
Q

vaccinations in patients undergoing splenectomy

A

HiB, pneumococcus, meningococcus types B and C

14 days AFTER splenectomy

112
Q

mycoplasm pnemonia diagnostic test

113
Q

most important ECG change to monitor for in aortic valve endocarditis

A

PR prolongation

could indicate an aortic root abscess

114
Q

equation for power of a study

A

1- probability of making type 2 error

115
Q

Howell-Jolly bodies association

A

hyposplenism

(you’re not so jolly without a spleen)

116
Q

serotonin syndrome treatment

A

cyproheptadine

(H1 and non specific 5HT antagonist)

117
Q

Lofgrens syndrome

A

acute form of sarcoidosis

polyarthralgia
bihilar lymphodenopathy
erythema nodosum
fever

118
Q

diagnostic test for hereditary spherocytosis

A

EMA binding test

119
Q

P450 enzyme inducers

A

CRAP GPS induces rage

Carbamazepine
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbitone
Sulphoylureas

120
Q

initial treatment for APML (acute promyelocytic myeloid leukaemia)

A

All-trans retinoic acid

(force immature granulocytes into maturation to resolve a blast crisis prior to more definitive chemotherapy)

121
Q

primary immunodeficiency caused by defect in B cell function

A

common variable immunodeficiency

122
Q

Wiscott Aldrich syndrome features

A

bloody diarrhoea
thrombocytopenia (low platelets)
eczema
recurrent bacterial infections

(X linked recessive condition affecting B and T cell signalling)

123
Q

rosacea treatment

A

mild flushing
–> topical brimonidine

mild to mod with pustules
–> topical ivermectin
(also topical metronidazole/azeliac)

mod to severe
–> topical ivermectin and oral doxycycline

124
Q

SSRI post MI

A

sertraline

125
Q

Immunoglobulin which activates B cells

126
Q

most common bateria in neutropenic sepsis

A

gram positive, coagulase negative

staph epidermidis

127
Q

cause of regular canon waves

128
Q

cause of irregular canon waves

A

complete heart block

129
Q

stain used to confirm diagnosis of pneumocystis carinii

A

silver stain

130
Q

sickle cell disease aplastic crisis symptoms

A

sudden drop in Hb
bone marrow suppression–> reduced reticulocyte count
assocaited with parovirus infection

131
Q

methaemogloblinaemia treatment

A

methylthioninium chloride

132
Q

SSRI with highest incidence of discontinuation symptoms

A

paroxetine

(Paroxetine causes Problems when it is dicontinued)

133
Q

drugs associated with photosensitivity

A

thiazides
tetracyclines
amiodarone
sulphonylureas and sulphonamides
psoralens

134
Q

NNT calculation

A

1- absolute risk reduction

134
Q

treatment for anthrax

A

ciprofloxacin

135
Q

pain in hands and feet
angiokeratomas
decreased ability to sweat
GI problems
tinnitus and hearing loss
corneal opacity or corneal verticillata

A

Fabry disease

136
Q

markers used to monitor haemochromatosis

A

transferrin saturations
ferritin

137
Q

cancer associated with CA15-3 tumour marker

A

breast cancer

138
Q

most common cardiac defect associated with Marfans syndrome

A

dilation of aortic sinuses

139
Q

mixed alpha and beta receptor antagonist

A

carvedilol

140
Q

management of stress incontinence

A
  1. pelvic floor exercises
  2. duloxetine
  3. retropubic midurethral tape procedures
141
Q

management of urge incontinence

A
  1. bladder retraining
  2. oxybutynin (avoid in frail and elderly- use mirabegron instead)
    tolterodine
142
Q

mechanism of action of duloextine in stress incontinence

A

increases the concentration of serotonin and noradrenaline in the presynaptic cleft of the pudendal nerve—>increased contraction of urethral sphincter muscles

143
Q

legionella treatment

A

macrolide e.g. clarithromycin

144
Q

autoantibody associated with polyarteritis nodosa

A

no antibody is likely to be positive

145
Q

common complication of PCP

A

pneumothorax

146
Q

DEXA scan result of -1.0 to -2.5

A

osteopenia

147
Q

DEXA scan result of less than -2.5

A

osteoporosis

148
Q

sarcoid CXR changes stages

A

stage 1: BHL
stage 2: BHL and infiltrates
stage 3: infiltrates
stage 4: fibrosis

149
Q

tumour lysis blood levels

A

high urate
high potassium
high phosphate
LOW CALCIUM

(high phosphate will chelate calcium in the blood)
(PUKE Calcium= Phosphate Urate Kpotassium Elevated. Calcium low)

150
Q

ethylene glycol antidote and mechanism of action

A

fomepizole

(competitive inhibitor of alcohol dehydrogenase)

151
Q

most common type of Hodgkins lymphoma

A

nodular sclerosing

(associated with Reed Sternberg cells)

152
Q

What is the use of leukocyte alanine phosphatase levels

A

LAP is found in mature WBC

Low LAP levels are associated with conditions with high immature WBC -e.g. CML

high LAP levels are associated with conditions with mature WBC e.g. myelofibrosis

153
Q

how is cryptosporidium diagnosed?

A

stool sample- turns red on acid fast staining

154
Q

Features of Parkinsons malignant syndrome

A

presents like neuroleptic malginant syndrome with hyperthermia, confusion, rigidity and increased RR HR BP

caused by abrupt withdrawal of Parkinsons meds

treatment= BROMOCRIPTINE

155
Q

primary immunodeficiency disorders involving both T and B cells

A

SCID
Wiscott Aldrich Syndrome
Ataxic telangiectasia

SCID WAS ATAXIC

156
Q

first line treatment for lichen planus

A

POTENT topical steroids

157
Q

autoantibodies most specific for dermatomyositis

158
Q

causes of predominantly sensory neuropathy

A

uraemia
alcoholism
B12 deficiency
leprosy
amyloidosis
diabetes

159
Q

causes of predominantly motor neuropathy

A

Guillian Barre
Charcot Marie Tooth
porphyria
lead poisoning
diptheria
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

160
Q

When is a Wilcoxon signed rank test used?

A

To compare a before and after following an intervention on the same group

(compares 2 sets of observations on a single sample)

161
Q

mechanism of action of amphotericin B

A

binds with ergosterol

(component of fungal cell membranes–>forms pores–>cell wall lysis–> fungal death)

162
Q

most common cardiac complication in myotonic dystrophy

A

1st degree heart block

163
Q

treatment for severe symptomatic mitral stenosis

A

percutaneous mital commissurotomy

164
Q

most common cause of congenital adrenal hyperplasia

A

21-hydroxylase deficiency

165
Q

TTP symptoms

A

thrombocytopenia
neurological symptoms
renal failure
fever
anaemia

166
Q

autoantibodies associated with idiopathic membranous glomerulonephritis

A

anti phospholipase A2

167
Q

mechanism of action of vassopression in von Willebrands disease

A

induces release of von Willebrand factor from endothelial cells

168
Q

mechanism of action of tetanus toxin

A

inhibits GABA release

169
Q

absolute risk reduction

A

Control event rate - experimental event rate

170
Q

Number needed to treat

A

NNT= 1- absolute risk reduction

(absolute risk reduction= control event rate - experimental event rate)

171
Q

type of motor neurone disease with the worse prognosis

A

progressive bulbar palsy

172
Q

Why are ACEi contraindicated in HOCM?

A

ACEi reduce afterload which can worsen the LVOT (LV outflow tract obstruction) gradient

**nitrates and ionotropes should also be avoided

173
Q

Features of Familial Mediterranean Fever

A

Autosomal recessive

Attacks which normally last 3 days of:
Fevers
Abdominal pain (peritonitis)
Pleurisy
pericarditis
erysipeloid rash on lower limbs
arthritis

treat with CHOLCHICINE

174
Q

cardiac marker used to look for reinfarction after MI

175
Q

markers of bone turnover which would be rasied in Pagets disease

A

hydroxyproline
urinary N telopeptide
serum C telopeptide
Procollagen type 1 N terminal propeptide

176
Q

severe LVF pulse

A

pulsus alterans

177
Q

flu like illness–>brief remission–> jaundice and haematemesis

A

Yellow fever

178
Q

investigation of choice for bile acid malabsorption

A

SeHCAT test

(patient ingests Selenium-75-labelled homocholic acid taurine and then gets a whole body gamma scan 7 days after. Low retention- think bile acid malabsorption)

179
Q

tumour associated with high levels of bombesin

A

small cell lung cancer

180
Q

contents of cryoprecipitate

A

vWF Factor VIII and fibrinogen

181
Q

most important factor to consider when deciding whether to give cryoprecipitate

A

give if low fibrinogen levels (to help clot formation)

(normally used in DIC, liver failure, after massive transfusion)

182
Q

antibody associated with idiopathic membraneous glomerulonephitis

A

anti phospholipase A2

183
Q

rare causes of papilloedema

A

vitamin A toxicity
hypocalcaemia and hypoparathyroid

184
Q

mechanism of action of bicalutamide

A

androgen receptor blocker

(used in prostate cancer)

185
Q

anti Yo antibodies

A

related to paraneoplastic cerebellar degeneration

(assoc with gynaecological cancers such as ovarian and breast)

186
Q

anti Hu antibodies

A

related to paraneoplastic neurological symptoms e.g. painful sensory neuropathies

(assoc with small cell lung cancer)

187
Q

conditions assoc with Eisenmenger’s syndrome

A

Atrial septal defect
Ventricular septal defect
PDA

188
Q

Condition associated with tear shaped piokilocytes

A

myelofibrosis

(myeloCRYbrosis)

189
Q

Function of peroxisomes

A

catabolism of long chain fatty acids

190
Q

first line agent for treatment of multifocal atrial tachycardia

191
Q

testing for haemochromatosis

A

Screening: transferrin saturations> ferritin
Family members: HFE gene analysis

192
Q

renal transplant (mostly over 4 weeks ago) and new infectious symptoms likely cause?

193
Q

HIV, neurological symptoms and SINGLE homogenous ring-enhancing lesion on CTB

A

CNS Lymphoma

194
Q

Most common cause of brain lesions in HIV?

A

toxoplasmosis

195
Q

Conversion disorder symptoms

A

Functional neurological disorder usually acute loss of sensory or motor function

196
Q

most common symptoms of drug induced lupus

A

arthralgia
myalgia
skin (e.g. malar rash) and pulmonary involvement (e.g. pleurisy) are common
ANA positive in 100%, dsDNA negative
anti-histone antibodies are found in 80-90%
anti-Ro, anti-Smith positive in around 5%

(normally resolves on stopping the drug)

197
Q

cavernous sinus thrombosis symptoms

A

headache
proptosis
unilateral facial oedema
photophobia
palsies of cranial nerves which pass through (CN III, IV, V, VI)

198
Q

treatment of Paget’s disease of the bone

A

IV bisphosphonates

198
Q

treatment options for metastatic bone pain

A

opioids
bisphosphonates
RT

198
Q

most common and severe form of renal disease in SLE patients

A

diffuse proliferative glomerulonephritis

199
Q

what must be excluded in a patient with a third nerve palsy and headache?

A

posterior communicating artery aneurysm

200
Q

investigation of choice for CLL

A

immunophenotyping

201
Q

most common cause of endocarditis less than 2 months post valve surgery

A

staph epidermidis

202
Q

most common cause of endocarditis 2 months after valve surgery

A

staph aureus

203
Q

thyrotoxicosis with tender goitre

A

de Quervians thyroiditis

204
Q

management of polycythemia rubra vera

A

aspirin (patients are at a higher risk of CVS events)
venesection
hydroxyurea (chemotherapy)

205
Q

role of IFN-γ

A

produced by Th1 cells to recruit macrophages

206
Q

oncogene associated with neuroblastoma

A

n-MYC

(think n for neuroblastoma)

207
Q

which cells mediate hyperacute organ rejection

208
Q

what is tolvaptan

A

a V2 receptor antagonist

(it reduces water absorption without sodium loss)

208
Q

Mechanism of action of hydrazine

A

Acts onsmooth muscle receptors of arterioles causing vasodilation and reduced systemic vascular resistance

209
Q

Mechanism of actionof monoxidine

A

Centrally acting antihypertensive
Stimulates imidazole receptorsin the brain–> reduced sympathetic outflow–> reduced SVR

210
Q

Metabolic causes of nephrogenic diabetes insipidus

A

Hypokalaemia
Hypercalcaemia

211
Q

first line treatment for TTP

A

plasma exchange

212
Q

which treatment for Graves may make thyroid eye disease worse?

A

radio-iodine

213
Q

Jarisch-Herxheimer reaction

A

Fever reaction with muscles aches, headache and transient rash which occurs 24 hours after starting abx for conditions suchs as Lyme disease and syphilis

214
Q

Golimumab mechanism of action

A

TNF alpha antagonist

215
Q

drug used to prevent calcium oxalate renal stones

A

thiazide diuretics

(increases distal tubular calcium resorption)

216
Q

contraindication for prescribing nicorandil in angina

A

LV failure

217
Q

Tetralogy of Fallot abnormalities

A

VSD
over-riding aorta
pulmonary artery stenosis
right ventricular hypertrophy

218
Q

mechanism of action of aciclovir

A

inhibits DNA polymerase

219
Q

mechanism of latanoprost

A

reduces uveoscleral outflow

219
Q

mechanism of action of timolol

A

reduces aqueous production

220
Q

mechanism of action of pilocarpine

A

muscarinic agonist –>pupil constriction–> increased uveoscleral outflow

221
Q

treatment of severe campylobacter infection

A

clarithromycin

222
Q

plasmodium species with the shortest erythrocyte replication cycle

A

p. knowlesi

(the accelerated cycle results in the rapid multiplication of the parasite, leading to notably high parasite counts in a brief timeframe.)

223
Q

long QT syndrome is associated with loss of function of which channels

A

loss of function/ blockage of K+ channels

224
Q

causes of hypokalaemia and hypertension

A

11 beta hydroxylase deficiency
Liddles syndrome
Conns syndrome
Cushings syndrome

225
Q

causes of hypokalaemia WITHOUT hypertension

A

Barters syndrome
Gitelmanns syndrome
diuretics
GI loss
Type 1 and 2 renal tubular acidosis

226
Q

Jervell Lange Nielsen syndrome

A

inherited long QT syndrome
sensorineural deafness

226
Q

organism associated with bacterial vaginosis

A

Gardnerella vaginalis
(Gram positive cocco bacilli)

227
Q

relative risk calculation

A

EER/CER

(experimental event rate/ control event rate)

228
Q

likelihood ratio for a positive test result

A

sensitivity / (1-specificity)

how much the odds of having the disease increase when the test is positive

229
Q

likelihood ratio for a negative test result

A

(1-sensitivity)/ specificity

how much the odds of having the disease decrease when the test is negative

230
Q

calculation for standard error of the mean

A

standard deviation / square root of the number of patients

231
Q

dabigatran mechanism of action

A

direct thrombin inhibitor

232
Q

MRIB findings associated with Wernickes syndrome

A

enhancement of mamillary bodies

233
Q

drug used in the management of Familial Mediterranean Fever

A

cholchicine

234
Q

Leiners disease

A

severe seborrhoeic dermatitis which begins in infancy
assoc with recurrent infections and diarrhoea
C5 deficiency

235
Q

how to tell if AKI is a pre renal uraemia or ATN

A

in pre renal uraemia, kidneys hold onto sodium to try to conserve volume

(low urinary sodium, high urine osmolality, raised serum Ur:Cr ratio)

236
Q

treatment of Ramsay Hunt

A

oral aciclovir and oral steroids

236
Q

teicoplanin mechanism of action

A

inhibits bacterial cell wall formation

236
Q

treatment for Chagas disease

A

Benznidazole

(kills the parasite Trypanosoma cruzi in both the acute and chronic phases.)

236
Q

antibiotic used to treat cholera

A

doxycycline

237
Q

mechanism of action of elvitegravir

A

anti-retroviral - blocks the enzyme which allows integration of viral genome into the host DNA

(-GRAvirs prevent inteGRAtion)

238
Q

pleural fluid with low glucose is suggestive of

A

rhematoid arthritis
tuberculosis

239
Q

pleural fluid with raised amylase is suggestive of

A

pancreatitis
oesophageal perforation

240
Q

pleural fluid with heavy blood staining is suggestive of

A

mesothelioma
PE
TB

241
Q

All patients with a pleural effusion assoc with sepsis or pneumonia should have pleural fluid sampled. What is the criteria for drainage?

A

If fluid is cloudy or turbid

pH less than 7.2

242
Q

indications for permanent pacemaker insertion in patients with bradycardia

A

symptomatic bradycardia
trifascicular block
sinus pause of over 3 seconds
mobitz type 2 HB

243
Q

Treatment of Legionella pneumonia

A

erythromycinor clarithromycin

(abx needs to penetrate the plasma membrane of alveolar macrophages where Legionella hides)

244
Q

immunosuppresive drug used in renal transplant associated with hyperkalaemia

A

tacrolimus

245
Q

mycobacterium avium treatment

A

rifampicin
ethambutol
clarithromycin

(Presents similar to mycobacterium TB but causes marked hepatomegaly compared to focal liver lesions seen in TB- it RECs the whole liver)

246
Q

Clinical findings of C8/T1 paralysis/ Klumpkes paralysis

A

loss of sensation medial hand and forearm
Flexed fingers
Supinated forearm
Wrist extension
May have forearm and intrinsic hand muscle atrophy

247
Q

most common cause of biliary disease in HIV patients

A

sclerosing cholangitis

most commonly caused by infections such as CMV cryptosporidium and microsporidia

248
Q

phenytoin mechanism of action

A

binds to Na channels and increases their refractory period

249
Q

Definition of SNP- single nucleotide pleomorphism

A

substitution of one nucelotide for another

(most commonly found in non-coding DNA, but can be clinically significant in coding DNA)

250
Q

serum osmolality concentration

A

(2x Na) + (2x K) + Glucose + Urea

251
Q

cisplatin toxicity

A

nephrotoxicity
neurotoxicity- neuropathy and hearing loss

252
Q

site of action of haloperidol

A

area postrema- an area of the medulla

253
Q

ropinerole mechanism of action

A

dopamine receptor agonist

254
Q

muscle responsible for torticollis

A

ipsilateral sternocleidomastoid muscle contraction (causes chin to deviate to the opposite side)

255
Q

aneuploid definition

A

abnormal number of chromosomes

256
Q

lung cancer most associated with cavitating lung lesions

A

squamous cell carcinoma

257
Q

drugs associated with lithium toxicity

A

thiazide diuretics
ACEi/ ARBs
NSAIDS
metronidazole

258
Q

Chvostek’s sign

A

test for HYPOCALCAEMIA

Facial muscle twitching when tapping over the area of the facial nerve

(Chvostek’s sign is more sensitive and specific for hypocalcaemia than Trousseau’s sign)

259
Q

Trousseau’s sign

A

test for HYPOCALCAEMIA

Inflate the BP cuff above systolic pressure for 2-3mins –> induces carpal spasm

260
Q

coronary artery and ECG changes assoc with anterolateral MI

A

proximal LAD
aVL I V1-V6

261
Q

coronary artery and ECG changes assoc with inferior MI

A

RCA
II III aVF

262
Q

coronary artery and ECG changes assoc with posterior MI

A

Left circumflex (but can also be RCA)

V1-V3 changes
-horizontal ST depression
-tall broad R waves
-upright T waves
-dominant R wave V2

ST evelation in V7-V9

263
Q

Coronary artery and ECG changes assoc with lateral MI

A

Left circumflex

I aVL V5 V6

264
Q

Pharmacological treatment for bulimia not responding to CBT

A

high dose fluoxetine

265
Q

treatment for neuroleptic malignant syndrome

A

dantrolene

266
Q

marker used to assess prognosis in myeloma

A

B2 microglobulin

267
Q

CXR staging for sarcoidosis

A

stage 1: BHL
stage 2: BHL + infiltrates
stage 3: infiltrates
stage 4: fibrosis

mrcp part 1 (1 decks)

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