MRCP Part 1 Flashcards
Pathology of Turner’s Syndrome?
Coarctation of Aorta
Missing gene BAC
Bicuspid valve
Aortic root dilated
coarct Aorta
TB medications and side effects
Isoniazid= Ice causes numbness on the skin = peripheral neuropathy
Ethambutol = Eye = optic neuritis
Rifampicin = Red/orange body secretions
Pyrazinamide= P looks like a big toe = big painful toe bcz of hyperuricemia = Gout
Features and treatment of Leptospirosis
Spirocheate
Feats:
fever, malaise, deranged renal function, meningism
Sewers, farmers, abattoir, returning traveler
Tx:
doxy/penicillin
SBP criteria
Paracentesis with Neuts >250
Antiemetics MoA
cyclizine
Ondansetron
metoclopramide
promethazine
cyclizine NS AH
Ondansetron - 5-HT3
metoclopramide - D2 Ant
promethazine - sed AH
VHL Von Hippel Lindau
Many cancers
AD
neoplasias
retinal haemorrhages
renal cysts/Renal cell carcinoma
pheo
Malarias and cycles
Know Forty Five Malaria
Knowlesi - 24
Falc/Ovale/vivax - 48
Malariae - 72
LESCH:
Lesch-Nyhan syndrome
Lip biting and fingernail biting
Excessive uric acid production
Self-mutilation
Choreoatheosis
HGPRT deficiency
- Hyperuricaemia, Gout, pissed off behaviour, retarded, tremor - chorea
A-H X-linked recessive conditions
A - Androgen insensitivity syndrome
B - Beckers/Duchenes
C - colourblindness
D - DI (nephrogenic)
E - eyes (retinitis pigmentosa)
F - Fabry
G - G6PD deficiency
H - haemophilia A/B, Hunter’s
Long QT Causes
A-E hypo
A: anArrhythmic: ie Amiodrone
B: anBiotics: Macrolides, Quinolone
C: pCychotics: Haloperidol
D: antDepressant: SSRI, TCA
E: antEmetics: Ondansetron
Hypo ( hypokalemia, hypomagnesaemia, hypocalcemia)
Causes of LAD and RAD
LAD:
LBBB, L ant Hemiblock, obesity, ostium ASD, inferior MI, hyperK, WPW
RAD:
Right sided HF, R hypertrophy, PE, COPD - Cor pulmonale, L post hemiblock, secundum ASD
Combined B and T cell disorders
WASH
Wiscot-aldrich
Ataxia telangiectasia
SCID
Hyper IgM
SCID was ataxic
B cell disorders
ABD or ABC - IgA/ Brutons/CVID
IgA def
Bruton’s
CVID
T cell disorders
DiGeorge
Neutrophil disorders
GHL
granulomatous disorder
chediak-Higashi
leukocyte adhesion def
Pellagra
Niacin B3
dementia, diarrhoea, dermatitis
Beriberi
Thiamine B1
Wet - cardiomyopathy
Dry - peripheral neuropathy
Causes of Hypokalaemic alkalosis
alphabetical:
Barters - Loop NKCC2 defect - LOTS of Drinks (polyuria and polydipsia)
Gitlemans - DCT thiazide sensitive Na/Cl co transporter
Liddle’s - collecting duct Epithelial sodium channels (hypertensive)
liquorish
Seminoma bloods
Seminoma –> Semen –> pregnancy and rise in HCG alone
Lung cancer RFs
NARCOS
Nickel
Arsenic / asbestos
Radon
Cryptogenic FA / chromate
Omitt
Smoking
Seizure treatment
Most M needs Valp, F lame/keppra apart from absence FL ethosux
Gen T-C
Male - valp
F - lamotrigine/keppra
Absence
FL: ethosuxamide
SL: M valp, F lamotrigine/Keppra
Focal
FL: lamotrigine/Keppra
SL: carbamazepine/oxcarbazepine/zonisamide
Myoclonic
M valp, F Keppra
Tonic/Atonic
M valp, F lamotrigine
Molecular biology techniques:
Western Blot
Northern
Southern
Eastern
Western - proteins
Northern - RNA
Southern - DNA
Eastern -post tranlational protein mods
SNOW (South - NOrth - West)
DROP (DNA - RNA - Protein)
Anticoagulant / DOAC targets
apixaban
dabigatran
Abciximab
daltaparin
Target Xa
apiXaban - Xa
Target both Xa +thrombin -= PARIN
Dalteparin
Target IIa (thromBin)
DaBigatran
Abciximab
Glycoprotein IIB/IIIA
Clopi
ADP receptor inhibitors
CYP Inducers
CRAP GPS
Carbemaz
Rif
chronic alcohol
phenobarb
Grisfulvin
Phenytoin
smoking, St John
CYP Inhibitors
SICKFACES.COM
SSRI , isoniazid, clari, erythro, fluconazole/ketoconazole, acute alcohol, allopurinol/amioderone, sodium valp, cimetidine, omeprazole, metronidazole
Ritonavir
Translocation abnormalities (haem)
t(8:14)
t(9:22)
t(11:14)
t(14:18)
t(15:17)
8urkitts - t(8:14)
9hiladel9hia - t(9:22)
11antle - t(11:14)
Four-licular Lymphoma - t(14:18)
Acute Promyelocytic Leukaemia - t(15:17)
ALL - 12:21 - L as number is 1 and there are 2 of the
acute promyelocytic = the M3 subtype of AML (5 words, 17 letters for t(15:17)) = RARA Gene (Rare, Auer rods, Relatively young (for AML), All trans retinoic acid sensitive (treatment)
NB AML with Ch 5, 7 is BAD
Ways to remember stat significance tests
(Mann-)Whitney Houston can sing many scales.
You learnt normal distribution as a school student - t tests
Wilcoxon - theres an ‘o’ before and after the ‘x’
speaRman’s (non-Para) or Pearson (para) = coRRellation
Chi squared = proportions/percentages
Rifampicin MoA
inhibits RNA synthesis
Antibiotics MoA
● Buy AT 30
Aminoglycosides
Tetracyclines
CELL for 50
Clindamycin
Erythromycin
Linezolid
● Cell wall - my favourite - penicillin and cephalosporins
Protein synthesis –> Core Medical Trainee is Forever Alone
- Chorampenicol
- Macrolide
- Tetracycline
- Fusidic acid
- Aminoglycosides
RNA synthesis - Rifampicin
DNA synthesis - Miss cutie (MS QT)
- Metro
- Sulphonamide
- Quinolone
- Trimethopri
(Copied)
Ix into systemic mastocytosis?
Urinary histamines
Quick manifestations of
W-A syndrome
Friederich’s ataxia
AIP
Wiskott Aldrich syndrome triad small thrombocytopenia plus eczema plus Repeated infections
Friedreich ataxia lower limb neurological loss motor and reflexes
Acute intermittent porphyria 4ps
painful abdomen, polyneuropathy, psyciatric symptoms, port wine urine
Rickettsia diseases
Coxiella Burnetti
Rickettsia Rickettsi
Rickettsia typhi
Rickettsia prowzekeii
C(Q)oxiella burnetti = Q fever.
Rickettsia rickettsii = Rocky Mountain spotted fever.
Rickettsia typhi = endemic typhus.
Rickettsia prowazekii = epidemic typhus.
Ehrlichia = ehrlichiosis.
ALS adrenaline doses
ALS
1ml 1:1000 OR
10ml 1:10000
Anaphylaxis
0.5ml 1:1000
Interferon treatments
INF=
Alpha=A=V VIRAL=HEP B C HHV8
Beta= B=m ms
Gamma= GMA= GranoloMA MACROPHAGE
MoA paracetamol OD and liver injury
paracetamol OD metab produced toxic NAPQI to hepatocytes. Normally glutathione detoxifies but this to mercapturic acid. But gets depleted in OD.
NAC replenishes glutathione.
androgen receptor blockers / prostate Ca tx
Goserelin==> GnRH agonist
Androgen: A==>B==>C
First Sythensis Blocker, then Receptor Bloker
A==> Abiraterone==> Synthesis blocker
B==>Bicalutamide==>Receptor blocker
C==>Cyproterone==> Receptor blocker
N.B. any terone, means Steroidal, so CyproTerone==> Steroidal
Bicalutamide==> Non-steroidal
Pulmonary Arterial Hypertension management
Depends on if responsive to CCB - vasodilary
CCB if responsive
If not:
- Anything with ‘prost’ in the name = prostacyclin analogues
- Anything with ‘ent’ in the name = endothelin-1 receptor antagonist
- PDE4 inhibitor - sildafenil
TYPES OF COLLAGEN - PATHOLOGY:
Type 1 = O1 (Osteogenesis 1mperfecta).
Type 2 = chondrodysplasias
Type 3 = 3hlers-Danlos syndrome (E and 3 are mirror images).
Type 4 = Good4asture syndrome, 4lport’s syndrome (4 does look like an A and a P).
Type 5 = Variant form of Ehlers-Danlos syndrome (5 = V).
Child-Pugh scoring and Tx for HCC
Child-Pugh A cirrhosis:
* No Portal HTN
* Single lesions <2cm
= Surgical resection.
Child-Pugh A and B cirrhosis:
* 2-3 tumours <= 3 cm / 1 tumour <=5 cm
* No Vascular / Extrahepatic spread
= Liver transplantation (bridge - TACE or RFA)
Child-Pugh A or B cirrhosis:
* Good performance status,
* Vascular, Lymphatic / Extrahepatic spread
= Tyrosine Kinase inhibitor, Sorafenib,
Child-Pugh C cirrhosis:
* End-stage liver disease
* Poor candidates for therapy
= Symptomatically
Acute intermittent porphyria vs Porphyria cutanea tardia
AIP - porphobilinogen deAminase;
PCT - uroporphyrinogen deCarboxylase - UDC
UL pathologies
Lat Epi
Med Epi
De Quevarian (lat epi)
Lateral epi ( ext & supination)
Like Radial tunnil but here ext & pronation and pain distal
Medial epi ( flex & pronation) pain localize to epicondile
Looks like cubital tunnil but ithink pain here not localized.
Deqrevan base of thumb
Olocranon post aspect of elbow.
Collagen abnormalities
I
II
III
IV
V
type
I - Osteogenesis imperfecta
II - cartciLLage = chondrodysplasias
III - reticular fibres = E-D
IV - Basement membrane eg alport/goodpastures
V - cell/hair - Classic variant E-D
Modified Duke’s Criteria
Major
Minor
2 major
5 minor
1 major 3 minor
Major
1.B lood culture positive for IE / molecular assays
2.E ndocardial involvement
3.F ever
4.I mmunologic phenomena
5.V ascular phenomena
6. D rug abuse (or with Previous Heart conditions)
'’FIVE BD
Congenital diseases
Congenital toxoplasmosis - Eyes, brain
- all the Cs - cats, Chorioretinitis, cerebrocalcification, hydroceph
Congenital rubella - Eyes, ears, heart
Congenital CMV - Ears, rash
Parkinsonisms
Parkinsonism+ cognitive impairment +visual hallucination
[Lewy body dementia]
Parkinsonism+ cognitive impairment +Urinary incontinence
[ Normal pressure hydrocephalus]
Parkinsonism+ cognitive impairment +Vertical gaze impairment
[progressive supranuclear palsy]
Parkinsonism +Autonomic disturbance + cerebellar signs
[ Multiple system atrophy].
cytotoxic agents MoA
Cyclophosphamide, Ciclosporin, Cispltin
Bleomycin
Topotecan, Irenotecan
HydroxyuRea
docetaxel
Cyclophosphamide, Ciclosporin, Cispltin = Cross linking
Bleomycin = blows DNA = degrades formed DNA
Topotecan, Irenotecan = Topoisomerase inhibition
HydroxyuRea = Ribonucleotide Reductase inhibition
doceTaxel = microTubule disassembly inhibition
Vestibular neuronitis vs viral labyrinthitis?
viraL = hearing LOSS
A1AT classification
M = Normal
S = slow
Z = Very slow
PiMM = normal
PiMZ = heterozygous
PiSS = 50%
PiZZ = 10%
Live Vaccines
MY PITT
MMR, yellow, polio, influenza, TB, Typhoid, (rotavirus)
HIV / antiviral drug classes
- Navir - = protease inhibitors (never tease a pro)
- Tegra - = inTegrase inhibitors
- VIR - = NNRTI
Roc / tide = fusion inhibitor
Others = NRTIs
NRTIs end in ‘ine’
Pis: end in ‘vir’
NNRTIs: nevirapine, efavirenz
MEN types
1
2a
2b
1 = PPP
- para, pituitary, panc
2a = PPM
- para, pheo, Med thyroid
2b = PMN
- pheo, Marfan, NeuromaC, Med thyroid
Cryoblobinaemia
Igs preceipitae at 4 degrees reversible when warmed
- T1- raynauds/myeloma
(primary raynauds = 1?)
- T2 - RA/Hep C/lymphoma/sjogrens
- T3 RA
AD polycystic Kidney Disease Genes
Type 1 = chr 16
Type 2 = Chr 4
16 letters in polycystic kidney
Kallman’s vs kleinfelter’s
hypogonadism, delayed puberty, infertility, tall ish, low testosterone
KaLLmans = LOW FSH/LH
Bohr and Haldane effect
BOHR=Binding of O2 with Hb is Reduced in acidic environment.
Haldane effect = High O2 –> Down CO2 binding to Hb
HLA associations
HLA-B27 = reactive arthritis, Ank Spond
HLA-A3 = hereditAry hAemachromAtosis
HLA-B51 = Bechet’s
HLA-DQ2/DQ8 = cOEliac,
HLA-DR2 = gOOdpastures, narcOlepsy, SLE (T2 reaction)
HLA-DR3 = 3jogren3, PBC (3), dermatitis herpeteformi3, SLE
HLA-DR4 = T1DM, RA (4)
HLA CW6 / B13/17= psoriasis
Lung paraneoplastic Issues
Small Cell = head
- ACTH, ADH, AntiVGCaC lambert-eaton
Squamous cell = neck
- PTH, TSH
Adenocarcinoma = body
- gynaecomastia/OA
Lymphoma and CLL treatment acronyms
FCR - CLL
AVBD - Hodgkins
R-CHOP - Non-Hodgkins
Shortest number of letter to longest matches
CDJ - Creutzfeldt-Jakob disease cardinal features
C cerebellar signs
J jerks (myoclonus)
D dementia
Vit B deficiences
work down
B1thiamine - brain - wernickes / beri beri
B2 riboflavin - mouth
B3 niacin - diarrhoea - pellagra
B6 pyridoxine - peripheral neuropathy (think of feet)
Pupils:
Holmes Adie
Argyl-Robertson
RAPD
Third nerve
Holmes - ADILATED
Argyl-rob - small irregular, prostitute (accommodates and does not react), syph
RAPD - dilates when light shot to eye - marcus Gunn
Third nerve - dilated
Drugs that can be cleared with haemodialysis - mnemonic: BLAST
B - barbiturates
L - lithium
A - alcohol (ethylene glycol)
S - salicylates
T - theophylline
Molecular Biology techniques
SNOW (South - NOrth - West)
DROP (DNA - RNA - Protein)
STI Ulcers and LN
Syph
Chancroid - ducerii
LGV
Inguinal Lymphadenopathy is present in Syphilis, LGV and Chancroid
- Painless IL plus Painless ulcer - SyphiliS painleSS
- Painful IL plus Painless ulcer - LGV - LN
- Painful IL plus Painful ulcer - Chancroid - SHANK
Adreno Receptors
GPCR
A agonists vs antag
A1- SM/arteries
A2 - presynaptic
B agonists vs antag
B1 - heart
B2 - bronchial SM / vasodilation / relax GI
B3 - mirabegron (bladder) / lipolysis
Vitamin Defs
work down
B1 - brain- thiamine - wernickes, beri beri
B2 - mouth - riboflavin -> angular stomatitis
B3 - diarrhoea/dermatitis/dementia niacin- pellagra
B6 - neuropathy (think of feet)
Acetylator status
Acetylators travelled with ship to relax after stablization
Sulfunmides
Hydrlazine
Izonizid
Procainamide
Syphillis tests
Trep (TPHA) and non-trep (VDRL)
VDRL tests for antigen
TPHA is antibodies - remains POS after tx
Pemphigoid
Pemphigus
oid - deep - no oral inv - IgG and C3 at the dermoepidermal junction
Pemphigus - oral - antibodies directed against desmoglein 3
Steroid strengths
Mineralocorticoid Activity:
Fludrocortisone > Hydrocortisone > Prednisolone > Dexamethasone
Glucocorticoid Activity:
Dexamethasone > Prednisolone > Hydrocortisone > Fludrocortisone
Dex = sugar = Glucocorticoid activity
MGUS vs SM vs MM
Monoclonal Gammopathy of Uncertain Significance (MGUS):
▪︎M protein <30 g/l
▪︎BM plasma cells <10%
▪︎No CRAB features
Smoldering Multiple Myeloma:
▪︎M protein > 30 g/l
▪︎BM plasma cells 10-60%
▪︎No CRAB features
▪︎Rx: Observe + monitor
Multiple myeloma:
▪︎M protein >30g/l
▪︎BM plasma cells >30%
▪︎CRAB features
Light’s Criteria for pleural effusions
- Pleural fluid protein / Serum protein >0.5
- Pleural fluid LDH / Serum LDH >0.6
- Pleural fluid LDH > 2/3 * Serum LDH upper limit of normal
