MRCP Part 1 Flashcards
Which blood pressure medications should be avoided in patients taking lithium?
Diuretics, ACE-inhibitors and angiotensin II
Diuretics, ACE-inhibitors and angiotensin II receptor antagonists may cause lithium toxicity. The BNF advises that neurotoxicity may be increased when lithium is given with diltiazem or verapamil but there is no significant interaction with amlodipine. Alpha-blockers are not listed as interacting with lithium but they would not be first-line treatment for hypertension.
What should be given in ethylene glycol and methanol poisoning?
Fomepizole
What is the inheritance pattern of Alport’s syndrome?
X-linked dominant
Alport’s syndrome is inherited in an X-linked dominant fashion in 85% of cases. The condition is caused by a defect in the gene which codes for type IV collagen resulting in an abnormal glomerular-basement membrane. The disease is more severe in males with females rarely developing renal failure. The patient in this vignette presents classically for this condition, with childhood progressive renal failure becoming dialysis dependent in mid-life.
Low serum calcium, low serum phosphate, raised ALP and raised PTH?
Osteomalacia
What is a non-healing painless ulcer associated with a chronic scar indicative of?
squamous cell carcinoma (SCC)
Although sun exposure is the most common cause of SCC other risk factors include chronic wounds, burns, scars, radiation exposure and immunosuppression.
A sudden fall in haemoglobin without an appropriate reticulocytosis (3% is just above the normal range) is typical of what?
an aplastic crisis, usually secondary to parvovirus infection
Scoring system for hirsutism?
Ferriman-Gallwey
9 body areas are assigned a score of 0 - 4, a score > 15 is considered to indicate moderate or severe hirsutism
Bombesin is a tumour marker in what cancer?
Small cell lung carcinomas
Both trimethoprim and methotrexate work by inhibiting which enzyme?
Dihydrofolate reductase
When given alongside one another, patients can develop life-threatening myelosuppression due to the cumulative effect of the folic acid antagonism that occurs.
Since co-trimoxazole is a combination of trimethoprim and sulfamethoxazole, this effect occurs with the co-prescription of co-trimoxazole and methotrexate also.
Why might patients see a return of seizures after starting carbamazepine?
Auto-inhibition
Carbamazepine induces its own metabolism via the hepatic microsomal enzyme system CYP3A4 system. This process is known as auto-induction.
The half-life of carbamazepine decreases considerably as auto-induction takes place. In practical terms, this means that carbamazepine levels fall significantly (by about 50%) after several weeks of treatment, which may result in seizure recurrence within this period of auto-induction.
For this reason, the dose should be increased every 2 weeks.
Why does cement often cause contact dermatitis?
The alkaline nature of cement may cause an irritant contact dermatitis whilst the dichromates in cement also can cause an allergic contact dermatitis
What are the differences between impaired glucose tolerance and impaired fasting glucose?
IGT: due to resistance to muscle insulin.
IFG: due to resistance to hepatic insulin.
IGT is preceded by IFG.
Diplopia is not common in Parkinson’s disease and may suggest an alternative cause of parkinsonism such as what?
progressive supranuclear palsy
What is Eisenmenger’s syndrome and what may happen to the original murmur when it develops?
Eisenmenger’s syndrome is characterised by the reversal of the left-right shunt due to pulmonary hypertension.
The original murmur may disappear once Eisenmenger’s syndrome develops.
In terms of screening for liver cirrosis, who should transient elastography be offered to? (3)
- Hep C infected people
- Men drinking >50 units of alcohol per week / Women drinking >35 units per week (for several months)
- People diagnosed with alcohol-related liver diseases