MRCP Part 2 Flashcards
Positive interferon gamma release assay indicates?
Active or latent TB
Asian backpacker, frontal headache, maculopapular rash, fever with bradycardia, painless erythematous lesion with necrotic scar
Scrub typhus
ST elevation without reciprocal depression post MI
left ventricular aneurysm - predisposes to VTach and cardiac thrombo-embolisms
ST elevation and LoC
SAH
ethylene glycol treatment
fomepizole or ethanol
immediate management of weeverfish bites
soak affected limb in hot water as this allows denaturation of the poisonous proteins
indications for antivenin, given its high rate of anaphylaxis
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.
mainstay treatment of viper bites
supportive tx (fluids and analgesia)
risk factors for necfasc
diabetes, recent chickenpox
mobitz II warrants what kind of pacemaker
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.
minor bleeding, inr 5-8
stop warfarin, give intravenous vitamin K 1-3mg, and restart when INR < 5.0.
ecg changes in hypokalaemia
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
ecg appearance of AVRD ( arrhythmogenic right ventricular dysplasia)
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.
a. anti-centromere ab
b. anti-scl70
c. anti-jo antibody
a. limited cutaneous systemic sclerosis
b. diffuse systemic sclerosis
c. Polymyositis
complications of forward aortic dissection tear
- 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)
Treatment options for symptomatic stable angina on calcium blocker
- betablocker
if c/i
long-acting nitrate, ivabradine, ranolazine, nicorandil
treatment options for:
a. broad complex tachycardia
b. narrow complex tachycardia
c. unstable tachyarrhytmia
a. loading dose of amiodarone + 24hr infusion
b. adenosine
c. DC cardioversion
Indications for cardiac resynchronisation therapy in patients with symptomatic heart failure
left ventricular ejection fraction (LVEF) of 35% or less, and LBBB with a QRS duration > 130 msec.
Tall, long fingered, downward lens dislocation, learning difficulties, DVT
Homocystinuria
when to give oral vit k in patients taking warfarin
when inr >8 and no bleeding
Indications for mitral valve intervention in patients with mitral valve regurg
symptoms, left ventricular dysfunction, pulmonary hypertension, new atrial fibrillation and dilated left ventricle
Perc mitra clip vs mitral surgery
perc mitra clip indicated for patients unsuitable for surgery.
perc mitra clip less post op complications , but more likely to need further surgery
Perc mitra clip vs mitral surgery
perc mitra clip indicated for patients unsuitable for surgery.
perc mitra clip less post op complications , but more likely to need further surgery
haemophilia A is associated with which genetic condition
Turner’s syndrome
When is Ivabradine indicated for heart failure
sinus rhythm > 75/min and a LVEF < 35% and have not responded to to ACE-inhibitor, beta-blocker and aldosterone antagonist therapy
stokes-adams attack
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
mitral stenosis murmur
mid-diastolic murmur with loud s1. louder on expiration
How to confirm diagnosis of cutaneous leishmaniasis
punch biopsy
return from sudan with scaly, non-healing skin lesions from sandfly bites
cutaneous leishmaniasis
HIV pts with HLA B*5701 must avoid what drug in the ART regimen
abacavir (think avada kedavra - if you dont avoid, highly likely to have a fatal hypersensitivity reaction)
cerebral toxoplasmosis tx
pyrimethamine + sulphadiazine
tx options for latent tb
3 months of isoniazid (with pyridoxine) and rifampicin, or
6 months of isoniazid (with pyridoxine)
fish tank granuloma vs cutaneous leishmaniasis lesions
nodular or plaque like, unusual to be ulcerating vs large shallow ulceration, may also be dry or covered with a crust/scab
type 1 vs type 2 necfasc
type 1 - polymicrobial infection of subcutaneous tissue (organisms present include Bacteroides, Peptostreptococcus, E. coli, Enterobacter, etc)
type 2 - strep pyogenes
abx for bacteria with carbapemenase
olymyxins (e.g. colistin), tigecycline, fosfomycin or aminoglycosides (e.g. gentamicin)
a. chikunguya vs b. dengue
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
viral haemorrhagic fever, exposure to bats
marbug virus
—— is positive in both past and current syphillis infection
TPPA (Treponema pallidum particle agglutination assay)
chronic hepatitis B infection
pruritic rash, deteriorating vision, history of being bitten by blackflies - treatment?
ivermectin - this is river blindness
——– are diagnostic of yellow fever
councilman bodies
what agents to make blood runny in unstable angina and NSTEMI if angio within 24h vs if not
aspirin, clopi, unfractionated heparin - otherwise use fondaparinux
complete heart block (CHB) in —————- requires pacing while CHB in —————- can be managed conservatively (providing obs are ok obv) . Related to MI
a. anterior MI
b. inferior MI
triad for still’s disease
fever, joint pain, bumpy salmon coloured rash
treatment for strongyloidiasis
ivermectin
———- is the hookworm causing cutaneous larva migrans
Ancyclostoma braziliense.
in what situation can you start alendronate without need for dexa scan
patients age >=75 following fragility fracture
HIV, neuro symptoms, single brain lesions with homogenous enhancement
CNS lymphoma
Equations for calculating:
a. Anion gap
b. Osmolality gap
a. Anion gap = Sodium - (Chloride + Bicarbonate)
b. Osmolality gap = Osmolality gap = Measured osmolality - ((2*Sodium) + Urea + glucose))
muscle pain and stiffness following exercise, muscle cramps, myoglobinuria,
low lactate levels during exercise
McArdle disease
MIBG scan is test for
Phaeochromocytoma
Investigations for stable angina
- Coronary angio
- Non invasive test eg stress echo
Palpitations suspected for AF, initial ECG NAD- investigations if episodes within 24h, or >24h apart
Within 24h - 24h ECG
more than >24h apart - event recorder ECG
Investigation with highest diagnostic yield for malignant mesothelioma
Video assisted thoracoscopy
Pleural fluid cytology is……….. in malignant mesothelioma
Non diaganostic
Spouse works as plumber, chronic onset of diffuse chest pain and profuse sweating. CXR shows R sided effusion and pleural plaques
Mesothelioma
Criteria of insertion of intercostal drain for secondary pneumothorax
SOB, over 50 years old, significant smoking history, rim of air >2cm
When should suction be applied for intercostal drains?
Persistent air leak or lungs not re-expanding after a few days of the intercostal drain
X linked hypogammaglobulinaemia and its treatment
Low globulin fraction (total protein minus albumin). Presents similarly to CF (bronchiec, recurrent chest infections, malabsorption). Tax with IVIG
Poor prognostic indicators for bradycardia
Recent asystole, mobitz II AV block, complete heart block, ventricular pause >3 s
Patchy consolidation, desaturates on exercise, probable HIV - treatment?
PCJ
Treatment is IV pentamidine and oral pred
Diagnostic criteria of ABPA
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)
Lung and eosinophilic conditions (6)
Loeffler syndrome
Chronic pulmonary eosinophilia
Hyper eosinophilic syndrome
ABPA
churg Strauss
Tropical pulmonary eosinophilia
Thoracoplasty?
Often used to treat TB back then
Rib resection in conjunction with loss of lung volume
Criteria for life threatening asthma
PEF <33% of best
SpO2 <92%
PaO2 <8
Normal PaCO2
Silent chest
Cyanosis
Poor resp effort
Arrhythmia
Exhaustion
Yellow nail syndrome triad
Primary lymphedema, recurrent pleural effusions, dystrophic yellow nails
Most helpful differentiating ECG feature for acute pericarditis is
PR depression in II and V6
PR elevation in avR
Recurrent chest infections, haemoptysis, chest pain, wheeze, flushing precipitated by alcohol
Carcinoid syndrome
widespread erythematous scaly rash involving the ears and its malignancy association
acrokeratosis paraneoplastica - a/w upper 1/3 digestive/respiratory tract sq cell carcinoma
treatment of cyanide poisoning
dicobalt edetate 300mg IV
treatment for katayama fever/schistosomiasis
praziquantel
which pancreatic cysts need follow-up due to malignant potential?
mucinous cystadenoma, intraductal papillary mucinous neoplasm,
androgen insensitivity syndrome
normal external female genitalia, primary amenorrhea, 46 xy karyotype. no ovaries, undescended testes
extrinsic allergic alveolitis - typical ct findingsn
upper zone nodular pattern of fibrosis
when would you not give EPO in CKD patients?
when they are hypertensive or have abnormal iron stores/vit b12/folate
severe barrets with high grade dysplasia and low grade dysplasia - management
HG - endoscopic mucosal ablation
LG - high dose PPI
LG dysplasia in barretts - monitoring
repeat endoscopy at 6 months
metastatic bladder cancer - receiving chemo - develop palpitations and AF and tetany - most likely cause?
hypomagnesemia (cisplatin often causes hypomagnesemia, which is a common chemotherapy for bladder cancer)
unfavourable abnormalities in AML
del or add (5q), del or add 7q, monosomies of chromosome 5 or 7
cicatricial alopecia
inflammation that injures hair follicles, resulting in permanent bald patches. eg a/w discoid lupus., tx is topical steroids
inclusion body myositis
most common myopathy in >50. targeted muscle wasting and weakness eg quadriceps and long finger flexors, that may be asymmetrical
myotonic dystrophy
typically in the third decade with muscle weakness, myotonia, infertility, frontal balding in men
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?
Brugada syndrome - implantable cardioverter-defibrillator
right bundle branch block + ST elevation in the right precordial leads associated with ventricullar fibrillation and sudden death
Brugada syndrome
bifascicular block vs trifascicular block
bifascicular block - RBBB with left anterior/posterior fascicular block
trifascicular block - bifascicular block with AV block
meningeal irritation, focal seizures, symptoms of inattention , CT showing bone erosion and evidence of chronic frontal sinus infection
think subdural empyema
sudden onset fever + myalgia + nausea + vomiting + non specific rash + flaccid paralysis similar to GBS + frank meningo-encephalitis
think west nile fever - especially when there’s something about new york
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
progressive multi-focal leukoencephalopathy
CSF leak –> meningitis - what are the likely organisms and what antibiotic treatment is appropriate?
staph aureus/epidermidis. trat with iv linezolid
treatment of non-atrophied areas of necrobiosis lipoidica
topical steroids
best insulin regime that allows for more changes in lifestyle eg more exercise
basal bolus regime
example of a ‘peak-less’ insulin
glargine
characteristics of TB meningitis
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
wide split second sound + RBBB + prominent pulmonary vasculature
Atrial septal defect - best visualised with TOE or R heart cathterization
pulmonary hypertension in pregnancy
associated with high mmortality (50%), if patients opt to continue pregnancy , they must be managed with anticoagulation, prostacyclin, oxygen
concentric erythematous bands forming a wood grain appearance - association ?
EGR (erythema gyratum terens) - associated with malignancy, particulalry sq cell lung ca, but also breast, bladder, cervical, stomach, and prostate cancers
HRCT showing bilateral centrally dilated thickened airways with signet rings
ABPA
drug that improves visual acuity and reducing progression of proliferative diabetic retinopathy
ranibizumab/ bevacizumab - recombinant humanised antibody fragment active against all forms of vegf
hard exudates adjacent to macula indicate ————— which is best treated with ———– or —————
macula oedema
focal laser therapy
anti vegf therapy
diarrhea wheeze flushing tricuspid regurgitation
carcinoid
chlamydia vs gonorrhea
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
treatment of juvenile myoclonic epilepsy. which anti epileptics to avoid?
sodium valproate, lamotrigine and levetiracetam. avoid carbamazepine and phenobarbitone
average increase in thyroxine for a pregnant woman
25-50 micrograms - there is a 30% increase in thyroid hormone requirements in pregnancy
extreme hyperthermia, rhabdomyolysis, renal impairment, low platelets, reduced GCS with dilated pupils
MDMA toxicitiy
young adult with intermittent malaena, despite normal OGD and colonoscopy fidnings
think meckel’s diverticulum
haemodynamically unstable haematemesis from a bleeding duodenal ulcer, with signs of type ii MI. poor surgical candidate
think angiography and selective arterial embolization
ideal steroid sparing agent for PMR and GCA
il-6 inhibitor such as tocilizumba
indication for gastric lavage in aspirin overdose (otherwise its activated charcoal)
presentation 1 hour after overdose , aspirin consumption of more than 500mg/kg
https://1963417514.rsc.cdn77.org/content/images/Picture%208.jpg spot diagnosis
cerebral abscess - look at the ring enhancing lesions
hearing loss, pulsatile tinnitus 1 year before lesions of cranial nerves 9, 10 and 11
glomus jugulare tumour
tinnitus, hearing loss, facial/trigeminal/cerebellar signs
acoustic neuroma
best imaging for visualising cerebello-pontine area
MRI
treatment approach of high grade glioma
surgical resection + adjuvant post-op RT and chemo (eg temozolomide)
use of stereotactic RT
for small, clearly defined cerebral tumours - this is a type of focussed RT
generalised myoclonus, short (think few months) progressive history of forgetfulness, agitation and speech problems
sporadic cjd
vcjd tends to occur in —- patients compared to scjd, and also tend to be more relentlessly progressive
younger
most specific test for confirming diagnosis of cjd
csf analysis of 14.3.3 protein and RTQulC test
blurred vision +/- d&v –> profound neuromuscular blockade with descending symmetrical paralysis, from CN
c. botulinum infection
lorry drivers and MI - when can they drive again?
stop driving , in 6 weeks post-intervention , needs an exercise tolerance test to be clear of residual chest pain/ECG changes
what is cardio index,, and what does a cardio index of less than 2 indicate
cardiac output divided by total body surface area. CI of <2 indicates cardiogenic shock
in patients with T2DM diagnosed with T1MI which type of treatment is best to avoid restenosis
drug eluting stents
palindromic rheumatism
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.
Mode of action of
a. ciprofloxacin
b. aminoglycoside/tetracycline/erythromycin
a. DNA gyrase inhibitor
b. interferes with functioning of ribosomes
hypertension, flank pain, micro/macro scopic haematuria
APKD
APKD associations
intracranial aneurysms, colonic diverticula, mitral valve prolapse, other organ cysts eg liver spleen
Progressive descending weakness, starting with blurred vision –> bulbar palsy –> extensive flaccid paralysis
botulism
neck spasms and trismus following metoclopramide + its treatment
acute dystonia related to metoclopramide. Tx is with anti-cholinergic
poor prognostic indicators for MS
short interval of time between MS episodes, motor cerebellar and sphincter involvement, progressive disease, male, older age
treatment of schizophrenia
- atypical antipsycotics eg risperidone
- clozapine
endometrial atrophy is associated with ————- post menopausal bleeding
steady, low level bleeding
tamoxifen increases the risk of ———– and ————-
endometrial carcinoma and uterine sarcoma
Imaging evaluation in IDA
a. Scopes (gastroscopy/colonoscopy) , ct colonography if not suitable
b. capsule endoscopy if -ve scopes and persistent IDA despite tx, ct/mr enterography
tx for meningococcal meningitis in patients who are pen allergic
chloramphenicol
small, asymptomatic primary pneumothorax follow up
discharge and f/u in 2-4 weeks
actinomyces
propionibacterium
clostridium
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
examples of gram negative bacteria
a.
b.
pseudomonas
e.coli
investigation of choice for PSC
MRCP
what is cystoscopy most useful for?
for assessment of bladder malignancy
mefenamic acid has a ——— therapeutic window and overdoses leads to significant ———- impairment
narrow
neurological
trimethoprim is associated with ——-
cholestatic jaundice
mebendazole is used to treat —–
threadworms (or worms in general)
hypertension, bilateral papilloedema, raised creatinine in a patient with systemic sclerosis + treatment (rationale of treatment?)
scleroderma renal crisis
tx is ACEI like captopril which is short acting and can be uptitrated rapidly
quinine and glucose
quinine tendsd to augment glucose mediated insulin release, therefore is often associated with hypoglycaemia when given as IV
which anti hypertesives is associated with erectile dysfunction
atenolol and bendroflumethiazide
imaging for investigation of colonic neoplasm if scope not aporpirate
CT barium
IBS, fe deficiency, low albumin
Coeliac
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
bronchiolitis obliterans
sudden visual loss, pale, swollen optic disc, headaches on side of head
arteritic ischaemic optic neuropathy
bivalirudin
direct thrombin inhibitor, can be used in thrombosis associated with HIT
HIT occurs because of ——— formed against ———– ——— -
antibodies
heparin factor 4
minimal change disease + hypertension
add ACEi
antibiotics for legionella
levofloxacin, azithromcyin
according to NASHH when is PEP recommended after a sharps/mucosal splash injury/sharing injecting equipment
only if a) HIV status known with b) unknown or detectable viral load
characteristic IV urogram appearance of analgesic nephropathy
bilateral clubbed calyces, ‘ring signs’, filing defect in one or more ureters
medullary sponge kidney
benign diffuse medullary cyst formation in the kidneys
Woman in her 30s, IBS symptoms, anaemia, raised ESR, kidney failure
suspicion of ovarian carcinoma
what would a small bowel follow through be useful for?
investigating for IBD, or small bowel neoplasm
Which antibodies are often associated IPF and what are typical imaging findings
ANA and RhF
BIbasal patchy shadowing
familial mediterranean fever
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
what is a complication of familiar mediterranean fever?
AA amyloidosis with kidney failure
mode of inheritance of tuberous sclerosis
autosomal dominant with variable penetrance
area of slightly darker skin, surround by small irregularly shaped, deeply pigmented lesions in areas of high sun exposure
lentigo maligna
large macular lesions with irregular margins and uniform brown pigmentation
solar lentigo
early phase treatment of erythrodermic psoriasis
cold dressings, emollients, ciclosporin , steroids
treatment for severe malaria
- iv artesunate
- iv quinine
sheehan’s syndrome
pan-hypopituitarism due to pituitary necrosis as a result of hypotension from the large volume haemorrhage at birth
