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MRCP facts I need to know > MRCP Part 2 > Flashcards

MRCP Part 2 Flashcards

1
Q

Positive interferon gamma release assay indicates?

A

Active or latent TB

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2
Q

Asian backpacker, frontal headache, maculopapular rash, fever with bradycardia, painless erythematous lesion with necrotic scar

A

Scrub typhus

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3
Q

ST elevation without reciprocal depression post MI

A

left ventricular aneurysm - predisposes to VTach and cardiac thrombo-embolisms

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4
Q

ST elevation and LoC

A

SAH

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5
Q

ethylene glycol treatment

A

fomepizole or ethanol

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6
Q

immediate management of weeverfish bites

A

soak affected limb in hot water as this allows denaturation of the poisonous proteins

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7
Q

indications for antivenin, given its high rate of anaphylaxis

A

severe systemic envenomations in patients with resistant hypotension, new ECG changes, significant rise in white cell count, raised CK, metabolic acidosis or swelling involving more than half the affected limb or crossing a joint boundary, e.g. beyond the wrist if bitten on the hand.

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8
Q

mainstay treatment of viper bites

A

supportive tx (fluids and analgesia)

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9
Q

risk factors for necfasc

A

diabetes, recent chickenpox

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10
Q

mobitz II warrants what kind of pacemaker

A

dual chamber pacemaker on setting DDD or DDDR. DDD pacing means that the pacemaker can record both atrial and ventricular rates and can pace either chamber as necessary. DDDR is the same but can adjust the heart rate to account for the need for higher cardiac output.

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11
Q

minor bleeding, inr 5-8

A

stop warfarin, give intravenous vitamin K 1-3mg, and restart when INR < 5.0.

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12
Q

ecg changes in hypokalaemia

A

u waves (waves that come after t waves and before p waves), small or absent T waves (occasionally inversion), prolonged PR interval, ST depression, and long QT

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13
Q

ecg appearance of AVRD ( arrhythmogenic right ventricular dysplasia)

A

an epsilon wave which is a small deflection buried at the end of the QRS complex usually best seen in the ST segment of V1 and V2.

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14
Q

a. anti-centromere ab
b. anti-scl70
c. anti-jo antibody

A

a. limited cutaneous systemic sclerosis
b. diffuse systemic sclerosis
c. Polymyositis

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15
Q

complications of forward aortic dissection tear

A
  • unequal arm pulses/blood pressures
  • stroke (difference in blood pressure going to the brain therefore causes some ischaemia)
  • renal failure (difference in blood pressure means the kidneys don’t get perfused as well)
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16
Q

Treatment options for symptomatic stable angina on calcium blocker

A
  1. betablocker
    if c/i
    long-acting nitrate, ivabradine, ranolazine, nicorandil
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17
Q

treatment options for:
a. broad complex tachycardia
b. narrow complex tachycardia
c. unstable tachyarrhytmia

A

a. loading dose of amiodarone + 24hr infusion
b. adenosine
c. DC cardioversion

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18
Q

Indications for cardiac resynchronisation therapy in patients with symptomatic heart failure

A

left ventricular ejection fraction (LVEF) of 35% or less, and LBBB with a QRS duration > 130 msec.

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19
Q

Tall, long fingered, downward lens dislocation, learning difficulties, DVT

A

Homocystinuria

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20
Q

when to give oral vit k in patients taking warfarin

A

when inr >8 and no bleeding

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21
Q

Indications for mitral valve intervention in patients with mitral valve regurg

A

symptoms, left ventricular dysfunction, pulmonary hypertension, new atrial fibrillation and dilated left ventricle

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22
Q

Perc mitra clip vs mitral surgery

A

perc mitra clip indicated for patients unsuitable for surgery.
perc mitra clip less post op complications , but more likely to need further surgery

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22
Q

Perc mitra clip vs mitral surgery

A

perc mitra clip indicated for patients unsuitable for surgery.
perc mitra clip less post op complications , but more likely to need further surgery

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23
Q

haemophilia A is associated with which genetic condition

A

Turner’s syndrome

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24
Q

When is Ivabradine indicated for heart failure

A

sinus rhythm > 75/min and a LVEF < 35% and have not responded to to ACE-inhibitor, beta-blocker and aldosterone antagonist therapy

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25
Q

stokes-adams attack

A

abrupt, transient loss of consciousness due to a sudden but pronounced decrease in the cardiac output, which is caused by a paroxysmal shift in the mechanism of the heart beat usually an atrioventricular block.
May see wide inverted T waves

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26
Q

mitral stenosis murmur

A

mid-diastolic murmur with loud s1. louder on expiration

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27
Q

How to confirm diagnosis of cutaneous leishmaniasis

A

punch biopsy

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28
Q

return from sudan with scaly, non-healing skin lesions from sandfly bites

A

cutaneous leishmaniasis

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29
Q

HIV pts with HLA B*5701 must avoid what drug in the ART regimen

A

abacavir (think avada kedavra - if you dont avoid, highly likely to have a fatal hypersensitivity reaction)

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30
Q

cerebral toxoplasmosis tx

A

pyrimethamine + sulphadiazine

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31
Q

tx options for latent tb

A

3 months of isoniazid (with pyridoxine) and rifampicin, or
6 months of isoniazid (with pyridoxine)

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32
Q

fish tank granuloma vs cutaneous leishmaniasis lesions

A

nodular or plaque like, unusual to be ulcerating vs large shallow ulceration, may also be dry or covered with a crust/scab

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33
Q

type 1 vs type 2 necfasc

A

type 1 - polymicrobial infection of subcutaneous tissue (organisms present include Bacteroides, Peptostreptococcus, E. coli, Enterobacter, etc)
type 2 - strep pyogenes

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34
Q

abx for bacteria with carbapemenase

A

olymyxins (e.g. colistin), tigecycline, fosfomycin or aminoglycosides (e.g. gentamicin)

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35
Q

a. chikunguya vs b. dengue

A

a. rashes appear on the torso and the arms, Joint pain in chikungunya is experienced in the hands, wrists, feet, and legs, often more debilitating
b. appear on the arms and the face, joint pains in shoulders and knees

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36
Q

viral haemorrhagic fever, exposure to bats

A

marbug virus

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37
Q

—— is positive in both past and current syphillis infection

A

TPPA (Treponema pallidum particle agglutination assay)

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38
Q

chronic hepatitis B infection

A
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39
Q

pruritic rash, deteriorating vision, history of being bitten by blackflies - treatment?

A

ivermectin - this is river blindness

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40
Q

——– are diagnostic of yellow fever

A

councilman bodies

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41
Q

what agents to make blood runny in unstable angina and NSTEMI if angio within 24h vs if not

A

aspirin, clopi, unfractionated heparin - otherwise use fondaparinux

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42
Q

complete heart block (CHB) in —————- requires pacing while CHB in —————- can be managed conservatively (providing obs are ok obv) . Related to MI

A

a. anterior MI
b. inferior MI

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43
Q

triad for still’s disease

A

fever, joint pain, bumpy salmon coloured rash

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44
Q

treatment for strongyloidiasis

A

ivermectin

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45
Q

———- is the hookworm causing cutaneous larva migrans

A

Ancyclostoma braziliense.

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46
Q

in what situation can you start alendronate without need for dexa scan

A

patients age >=75 following fragility fracture

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47
Q

HIV, neuro symptoms, single brain lesions with homogenous enhancement

A

CNS lymphoma

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48
Q

Equations for calculating:
a. Anion gap
b. Osmolality gap

A

a. Anion gap = Sodium - (Chloride + Bicarbonate)
b. Osmolality gap = Osmolality gap = Measured osmolality - ((2*Sodium) + Urea + glucose))

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49
Q

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

A

McArdle disease

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50
Q

MIBG scan is test for

A

Phaeochromocytoma

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51
Q

Investigations for stable angina

A
  1. Coronary angio
  2. Non invasive test eg stress echo
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52
Q

Palpitations suspected for AF, initial ECG NAD- investigations if episodes within 24h, or >24h apart

A

Within 24h - 24h ECG
more than >24h apart - event recorder ECG

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53
Q

Investigation with highest diagnostic yield for malignant mesothelioma

A

Video assisted thoracoscopy

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54
Q

Pleural fluid cytology is……….. in malignant mesothelioma

A

Non diaganostic

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55
Q

Spouse works as plumber, chronic onset of diffuse chest pain and profuse sweating. CXR shows R sided effusion and pleural plaques

A

Mesothelioma

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56
Q

Criteria of insertion of intercostal drain for secondary pneumothorax

A

SOB, over 50 years old, significant smoking history, rim of air >2cm

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57
Q

When should suction be applied for intercostal drains?

A

Persistent air leak or lungs not re-expanding after a few days of the intercostal drain

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58
Q

X linked hypogammaglobulinaemia and its treatment

A

Low globulin fraction (total protein minus albumin). Presents similarly to CF (bronchiec, recurrent chest infections, malabsorption). Tax with IVIG

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59
Q

Poor prognostic indicators for bradycardia

A

Recent asystole, mobitz II AV block, complete heart block, ventricular pause >3 s

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60
Q

Patchy consolidation, desaturates on exercise, probable HIV - treatment?

A

PCJ
Treatment is IV pentamidine and oral pred

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61
Q

Diagnostic criteria of ABPA

A

Asthma
Blood and sputum eosinophilia
IgE of >1000
Abnormal CXR (infiltrates, segmental or lobar collapse)
Confirmation of A. Fumigatus (positive skin test, fungal hyphae on microscopy, IgG serum participating antibody)

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62
Q

Lung and eosinophilic conditions (6)

A

Loeffler syndrome
Chronic pulmonary eosinophilia
Hyper eosinophilic syndrome
ABPA
churg Strauss
Tropical pulmonary eosinophilia

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63
Q

Thoracoplasty?

A

Often used to treat TB back then
Rib resection in conjunction with loss of lung volume

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64
Q

Criteria for life threatening asthma

A

PEF <33% of best
SpO2 <92%
PaO2 <8
Normal PaCO2
Silent chest
Cyanosis
Poor resp effort
Arrhythmia
Exhaustion

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65
Q

Yellow nail syndrome triad

A

Primary lymphedema, recurrent pleural effusions, dystrophic yellow nails

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66
Q

Most helpful differentiating ECG feature for acute pericarditis is

A

PR depression in II and V6
PR elevation in avR

67
Q

Recurrent chest infections, haemoptysis, chest pain, wheeze, flushing precipitated by alcohol

A

Carcinoid syndrome

68
Q

widespread erythematous scaly rash involving the ears and its malignancy association

A

acrokeratosis paraneoplastica - a/w upper 1/3 digestive/respiratory tract sq cell carcinoma

69
Q

treatment of cyanide poisoning

A

dicobalt edetate 300mg IV

70
Q

treatment for katayama fever/schistosomiasis

A

praziquantel

71
Q

which pancreatic cysts need follow-up due to malignant potential?

A

mucinous cystadenoma, intraductal papillary mucinous neoplasm,

72
Q

androgen insensitivity syndrome

A

normal external female genitalia, primary amenorrhea, 46 xy karyotype. no ovaries, undescended testes

73
Q

extrinsic allergic alveolitis - typical ct findingsn

A

upper zone nodular pattern of fibrosis

74
Q

when would you not give EPO in CKD patients?

A

when they are hypertensive or have abnormal iron stores/vit b12/folate

75
Q

severe barrets with high grade dysplasia and low grade dysplasia - management

A

HG - endoscopic mucosal ablation
LG - high dose PPI

76
Q

LG dysplasia in barretts - monitoring

A

repeat endoscopy at 6 months

77
Q

metastatic bladder cancer - receiving chemo - develop palpitations and AF and tetany - most likely cause?

A

hypomagnesemia (cisplatin often causes hypomagnesemia, which is a common chemotherapy for bladder cancer)

78
Q

unfavourable abnormalities in AML

A

del or add (5q), del or add 7q, monosomies of chromosome 5 or 7

79
Q

cicatricial alopecia

A

inflammation that injures hair follicles, resulting in permanent bald patches. eg a/w discoid lupus., tx is topical steroids

80
Q

inclusion body myositis

A

most common myopathy in >50. targeted muscle wasting and weakness eg quadriceps and long finger flexors, that may be asymmetrical

81
Q

myotonic dystrophy

A

typically in the third decade with muscle weakness, myotonia, infertility, frontal balding in men

82
Q

https://mypastest.pastest.com/QuestionImages/14/71795/71795.jpg aka coved ST elevation in leads V1-3 with inverted T waves - whats the definitive management?

A

Brugada syndrome - implantable cardioverter-defibrillator

83
Q

right bundle branch block + ST elevation in the right precordial leads associated with ventricullar fibrillation and sudden death

A

Brugada syndrome

84
Q

bifascicular block vs trifascicular block

A

bifascicular block - RBBB with left anterior/posterior fascicular block
trifascicular block - bifascicular block with AV block

85
Q

meningeal irritation, focal seizures, symptoms of inattention , CT showing bone erosion and evidence of chronic frontal sinus infection

A

think subdural empyema

86
Q

sudden onset fever + myalgia + nausea + vomiting + non specific rash + flaccid paralysis similar to GBS + frank meningo-encephalitis

A

think west nile fever - especially when there’s something about new york

87
Q

Patient has BG of neoplasm/chronic immunodeficiency state + several weeks of personality changes and intellectual impairment. this is followed by neurological focal signs, cortical blindness, seizures

A

progressive multi-focal leukoencephalopathy

88
Q

CSF leak –> meningitis - what are the likely organisms and what antibiotic treatment is appropriate?

A

staph aureus/epidermidis. trat with iv linezolid

89
Q

treatment of non-atrophied areas of necrobiosis lipoidica

A

topical steroids

90
Q

best insulin regime that allows for more changes in lifestyle eg more exercise

A

basal bolus regime

91
Q

example of a ‘peak-less’ insulin

A

glargine

92
Q

characteristics of TB meningitis

A

subacute onset with confusion, presentation in a homeless person, involvement of basal meninges, CSF of very high protein and very low glucose, secondary spinal menignitis

93
Q

wide split second sound + RBBB + prominent pulmonary vasculature

A

Atrial septal defect - best visualised with TOE or R heart cathterization

94
Q

pulmonary hypertension in pregnancy

A

associated with high mmortality (50%), if patients opt to continue pregnancy , they must be managed with anticoagulation, prostacyclin, oxygen

95
Q

concentric erythematous bands forming a wood grain appearance - association ?

A

EGR (erythema gyratum terens) - associated with malignancy, particulalry sq cell lung ca, but also breast, bladder, cervical, stomach, and prostate cancers

96
Q

HRCT showing bilateral centrally dilated thickened airways with signet rings

A

ABPA

97
Q

drug that improves visual acuity and reducing progression of proliferative diabetic retinopathy

A

ranibizumab/ bevacizumab - recombinant humanised antibody fragment active against all forms of vegf

98
Q

hard exudates adjacent to macula indicate ————— which is best treated with ———– or —————

A

macula oedema
focal laser therapy
anti vegf therapy

99
Q

diarrhea wheeze flushing tricuspid regurgitation

A

carcinoid

100
Q

chlamydia vs gonorrhea

A

gonorrhea typically presents with mucopurulent discharge, would also show gram negative cocci on microscopy. whereas chlamydia is the most common cause of PID, typically only has neutrophils on micrcoscopy

101
Q

treatment of juvenile myoclonic epilepsy. which anti epileptics to avoid?

A

sodium valproate, lamotrigine and levetiracetam. avoid carbamazepine and phenobarbitone

102
Q

average increase in thyroxine for a pregnant woman

A

25-50 micrograms - there is a 30% increase in thyroid hormone requirements in pregnancy

103
Q

extreme hyperthermia, rhabdomyolysis, renal impairment, low platelets, reduced GCS with dilated pupils

A

MDMA toxicitiy

104
Q

young adult with intermittent malaena, despite normal OGD and colonoscopy fidnings

A

think meckel’s diverticulum

105
Q

haemodynamically unstable haematemesis from a bleeding duodenal ulcer, with signs of type ii MI. poor surgical candidate

A

think angiography and selective arterial embolization

106
Q

ideal steroid sparing agent for PMR and GCA

A

il-6 inhibitor such as tocilizumba

107
Q

indication for gastric lavage in aspirin overdose (otherwise its activated charcoal)

A

presentation 1 hour after overdose , aspirin consumption of more than 500mg/kg

108
Q

https://1963417514.rsc.cdn77.org/content/images/Picture%208.jpg spot diagnosis

A

cerebral abscess - look at the ring enhancing lesions

109
Q

hearing loss, pulsatile tinnitus 1 year before lesions of cranial nerves 9, 10 and 11

A

glomus jugulare tumour

110
Q

tinnitus, hearing loss, facial/trigeminal/cerebellar signs

A

acoustic neuroma

111
Q

best imaging for visualising cerebello-pontine area

A

MRI

112
Q

treatment approach of high grade glioma

A

surgical resection + adjuvant post-op RT and chemo (eg temozolomide)

113
Q

use of stereotactic RT

A

for small, clearly defined cerebral tumours - this is a type of focussed RT

114
Q

generalised myoclonus, short (think few months) progressive history of forgetfulness, agitation and speech problems

A

sporadic cjd

115
Q

vcjd tends to occur in —- patients compared to scjd, and also tend to be more relentlessly progressive

A

younger

116
Q

most specific test for confirming diagnosis of cjd

A

csf analysis of 14.3.3 protein and RTQulC test

117
Q

blurred vision +/- d&v –> profound neuromuscular blockade with descending symmetrical paralysis, from CN

A

c. botulinum infection

118
Q

lorry drivers and MI - when can they drive again?

A

stop driving , in 6 weeks post-intervention , needs an exercise tolerance test to be clear of residual chest pain/ECG changes

119
Q

what is cardio index,, and what does a cardio index of less than 2 indicate

A

cardiac output divided by total body surface area. CI of <2 indicates cardiogenic shock

120
Q

in patients with T2DM diagnosed with T1MI which type of treatment is best to avoid restenosis

A

drug eluting stents

121
Q

palindromic rheumatism

A

characterized by sudden, multiple and recurring attacks of joint pain and swelling. Each episode may last from several hours to several days. Usually two or three joints are involved, which may vary in between attacks. The soft tissue around the joints may also be affected. After an attack, affected joints usually returns to normal without any permanent joint damage.

122
Q

Mode of action of
a. ciprofloxacin
b. aminoglycoside/tetracycline/erythromycin

A

a. DNA gyrase inhibitor
b. interferes with functioning of ribosomes

123
Q

hypertension, flank pain, micro/macro scopic haematuria

A

APKD

124
Q

APKD associations

A

intracranial aneurysms, colonic diverticula, mitral valve prolapse, other organ cysts eg liver spleen

125
Q

Progressive descending weakness, starting with blurred vision –> bulbar palsy –> extensive flaccid paralysis

A

botulism

126
Q

neck spasms and trismus following metoclopramide + its treatment

A

acute dystonia related to metoclopramide. Tx is with anti-cholinergic

127
Q

poor prognostic indicators for MS

A

short interval of time between MS episodes, motor cerebellar and sphincter involvement, progressive disease, male, older age

128
Q

treatment of schizophrenia

A
  1. atypical antipsycotics eg risperidone
  2. clozapine
129
Q

endometrial atrophy is associated with ————- post menopausal bleeding

A

steady, low level bleeding

130
Q

tamoxifen increases the risk of ———– and ————-

A

endometrial carcinoma and uterine sarcoma

131
Q

Imaging evaluation in IDA

A

a. Scopes (gastroscopy/colonoscopy) , ct colonography if not suitable
b. capsule endoscopy if -ve scopes and persistent IDA despite tx, ct/mr enterography

132
Q

tx for meningococcal meningitis in patients who are pen allergic

A

chloramphenicol

133
Q

small, asymptomatic primary pneumothorax follow up

A

discharge and f/u in 2-4 weeks

134
Q

actinomyces
propionibacterium
clostridium

A

a. may be found in female genital tract , gram positive rod with hyphae structures, a/w late prosthetic joint infxn
b. also gram positive rod, a/w late prosthetic joint infxn and acne
c. gram positive rod

135
Q

examples of gram negative bacteria
a.
b.

A

pseudomonas
e.coli

136
Q

investigation of choice for PSC

A

MRCP

137
Q

what is cystoscopy most useful for?

A

for assessment of bladder malignancy

138
Q

mefenamic acid has a ——— therapeutic window and overdoses leads to significant ———- impairment

A

narrow
neurological

139
Q

trimethoprim is associated with ——-

A

cholestatic jaundice

140
Q

mebendazole is used to treat —–

A

threadworms (or worms in general)

141
Q

hypertension, bilateral papilloedema, raised creatinine in a patient with systemic sclerosis + treatment (rationale of treatment?)

A

scleroderma renal crisis
tx is ACEI like captopril which is short acting and can be uptitrated rapidly

142
Q

quinine and glucose

A

quinine tendsd to augment glucose mediated insulin release, therefore is often associated with hypoglycaemia when given as IV

143
Q

which anti hypertesives is associated with erectile dysfunction

A

atenolol and bendroflumethiazide

144
Q

imaging for investigation of colonic neoplasm if scope not aporpirate

A

CT barium

145
Q

IBS, fe deficiency, low albumin

A

Coeliac

146
Q

patchy shadowing and hyperinflation seen in CXR of the transplanted lung, background of prev GVHD, mild raise of inflammatory markers (if immunosupressed), spirometry showing obstruction

A

bronchiolitis obliterans

147
Q

sudden visual loss, pale, swollen optic disc, headaches on side of head

A

arteritic ischaemic optic neuropathy

148
Q

bivalirudin

A

direct thrombin inhibitor, can be used in thrombosis associated with HIT

149
Q

HIT occurs because of ——— formed against ———– ——— -

A

antibodies
heparin factor 4

150
Q

minimal change disease + hypertension

A

add ACEi

151
Q

antibiotics for legionella

A

levofloxacin, azithromcyin

152
Q

according to NASHH when is PEP recommended after a sharps/mucosal splash injury/sharing injecting equipment

A

only if a) HIV status known with b) unknown or detectable viral load

153
Q

characteristic IV urogram appearance of analgesic nephropathy

A

bilateral clubbed calyces, ‘ring signs’, filing defect in one or more ureters

154
Q

medullary sponge kidney

A

benign diffuse medullary cyst formation in the kidneys

155
Q

Woman in her 30s, IBS symptoms, anaemia, raised ESR, kidney failure

A

suspicion of ovarian carcinoma

156
Q

what would a small bowel follow through be useful for?

A

investigating for IBD, or small bowel neoplasm

157
Q

Which antibodies are often associated IPF and what are typical imaging findings

A

ANA and RhF
BIbasal patchy shadowing

158
Q

familial mediterranean fever

A

genetic condition often presenting in <18
consists of short-lived (12-72hrs) attacks associated with fever (abdominal even peritonitic abdomen, joints, chest, scrotal, myalgia, erysipeloid

159
Q

what is a complication of familiar mediterranean fever?

A

AA amyloidosis with kidney failure

160
Q

mode of inheritance of tuberous sclerosis

A

autosomal dominant with variable penetrance

161
Q

area of slightly darker skin, surround by small irregularly shaped, deeply pigmented lesions in areas of high sun exposure

A

lentigo maligna

162
Q

large macular lesions with irregular margins and uniform brown pigmentation

A

solar lentigo

163
Q

early phase treatment of erythrodermic psoriasis

A

cold dressings, emollients, ciclosporin , steroids

164
Q

treatment for severe malaria

A
  1. iv artesunate
  2. iv quinine
165
Q

sheehan’s syndrome

A

pan-hypopituitarism due to pituitary necrosis as a result of hypotension from the large volume haemorrhage at birth

MRCP facts I need to know (2 decks)

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