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MRCP Part 1 > MRCP PassMed > Flashcards

MRCP PassMed Flashcards

1
Q

Deficiency of Selenium can cause what?

A

Dilated cardiomyopathy

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2
Q

Epileptics needing malarial prophylaxis use?

A

Atovaquone + proguanil

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3
Q

Which anti malarial cant you give in epilepsy?

A

Mefloquine

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4
Q

Alpha-1-antitrypsin genotype with highest risk of developing emphysema and low circulating levels?

A

PiZZ

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5
Q

Alpha-1 antitrypsin genotype with high circulating levels but rarely emphysema?

A

PiSS

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6
Q

Best way to test LVF?

A

MUGA scan
Often used in monitoring with chemotherapy

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7
Q

Malaria treatment two stages are?

A

ACT
Primaquine

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8
Q

What does primaquine do?

A

Destroy non-falciparum liver hypnozoites and prevents relapse

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9
Q

Pyoderma gangrenosum treatment?

A

Oral steroids

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10
Q

Sickle cell trait genotype?

A

HbAS

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11
Q

Sickle cell gene genotype?

A

HbSS

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12
Q

CD20 targetting monoclonal antibody?

A

Rituximab

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13
Q

Before starting rituximab screen for?

A

Hep B

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14
Q

S4

A

Severe AS
HOCM

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15
Q

What stimulates the release of gastrin from G cells?

A

Luminal peptides

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16
Q

Complete heart block following inferior MI management?

A

Common and if haemodynamically stable treat conservatively

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17
Q

Indications for temporary pacemaker?

A

Bradycardia with adverse features not responding to atropine
Anterior MI with complete heart block/ Mobitz type 2
Trifascicular block prior to surgery

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18
Q

Baby with haemodynamically significant PDA give?

A

Indomethacin for closure

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19
Q

Blood transmission of HIV by needlestick?

A

0.3%

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20
Q

Cavitating lung lesion infection?

A

Staph aureus

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21
Q

Dabigatran mode of action?

A

Direct thrombin inhibitor

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22
Q

Urge incontinence in elderly, with risk of anticholinergic burden?

A

Mirabegron

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23
Q

Action of mirabegron?

A

Beta 3 agonist

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24
Q

Action of oxybutynin?

A

anti muscarinic

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25
CT head with numerous small calcifications after travel abroad?
Neurocysticosis
26
What is Fabry disease?
Deficiency of alpha galactosidase A
27
How does Fabry disease present?
High urine protein and albumin Angiokeratomas to trunk Burning pain to hands and feet Dark urine after exercising
28
Gilteman syndrome?
Normotension Metabolic alkalosis Hypokalaemia Hypocalciuria
29
Bartter syndrome?
Normotension Metabolic alkalosis Hypokalaemia HYPERcalciuria
30
Hyperaldoesteronism?
Hypertension HyperNa
31
Neuropathic pain means not working next step?
Monotherapy, stop one and try another
32
Blistering rash including mucous membranes?
Pemphigus vulgaris
33
New diagnosis of dermatomyositis investigation?
Malignancy check
34
Dermatomyositis presentation?
Helicotrope rash Gottrons papules Proximal myopathy High CK
35
Octreotide mode of action?
Somatostatin analogue
36
Carcinoid syndrome treatment?
Octreotide
37
What avoids graft vs hots disease for blood products?
Irradiation
38
Heparin induced thrombocytopenia antibodies?
Against heparin and platelet factor 4
39
Friedrichs ataxia seen with:
Ataxia Nystagmus Cardiomyopathy High arched palate Optic atrophy DM
40
Inheritance of Friedrichs ataxia?
AR
41
Cause of friedrichs ataxia?
Trinucleotide repeat
42
Malt workers lung?
Aspergillus clavatus
43
Hereditary angioedema test?
C4 levels No histamine involved
44
Subacute degeneration of the cord affects the?
Lateral corticospinal tracts and dorsal coloumns
45
Traveller came home with persistent fever, rash sparing soles and palms, retroorbital headache and myalgia?
Dengue fever
46
Ancanthosis nigricans rash?
Gastric adneocarcinoma Hypothyroidism Prader-Willi PCOS DM Steroids
47
Treatment of acromegaly?
Surgery If refractory Octreotide, Pegvisomant
48
Mode of action of pegvisomant?
GH receptor antagonist
49
Listeria in CSF abx change?
Amoxicillin + gent
50
HLA-B5801
High risk of allopurinol induced SJS
51
Hungry bone syndrome
Sudden drop is PTH
52
Verapamil is contraindicated in?
Ventricular tachycardia
53
last
Last
54
Laxative for opioids?
Senna
55
Anti Emetic for chemotherapy
Ondansetron
56
Action of Ondansetron?
5HT3
57
Valvular disease in carcinoid?
Pulmonary stenosis
58
Pregnant women abx for UTI
Nitrofurantoin (except 3rd trimester- cefalexin) Pen allergic trimethoprim
59
Murmurs memory aid
MR PAN MS MD AR ED
60
Frequent NSAID with mild eosinophilia, rash and arthralgia?
Acute interstitial nephritis
61
Restless legs treatment?
Ropinirole
62
Sildenafil mode of action?
PDE 5 inhibitor
63
What is contraindicated with Sildenafil?
Nitrates and Nicorandil
64
Anti-Yo linked to?
Breast and ovarian Ca Cerebellar syndrome
65
MRI for MS?
MRI FLAIR
66
MRI for thyroid eye disease?
MRI STIR
67
NIV not recommended in?
Bronchiectasis
68
NIV ph for COPD?
<7.25
69
Bacterial infection in unpasteurised milk/ cheese?
Brucella
70
Antibiotic that increases the risk of MRSA?
Ciprofloxacin
71
SLE most common antibody?
ANA
72
SLE most common antibody?
ANA
73
Non specific urethritis?
Doxycycline 1 week
74
Mechanical aortic valve INT target?
3
75
Mechanical mitral valve INR target?
3.5
76
Travellers diarrhoea?
E. Coli
77
Ketamine mode of action?
NMDA receptor antagonist
78
Adrenaline mode of action?
G protein coupled receptor
79
Gosh and seafood poisoning?
Mercury
80
Visual defects, hearing loss and paraesthesia poisoning?
Mercury
81
Visual defects, hearing loss and paraesthesia poisoning?
Mercury
82
VBG of renal tubular acidosis?
NAGMA
83
Oropharyngeal cancer cause?
HPV 16+18
84
AML poor prognosis?
Deletion 5 and 7
85
Chemo agent causing hypoMg?
Cisplatin
86
SGLT2 inhibitor SE?
Fourniers gangrene
87
SGLT2?
Gliflozins
88
SGLT2?
Gliflozins
89
What secretes surfactant?
Type 2 pneumocysts
90
How long to monitor anaphylaxis after?
At least 2 hours
91
Does SJC have mucosal involvement?
Yes
92
What is dermatitis herpetiformis?
Autoimmune papules and pustules on extensors, pruritic
93
What is dermatitis herpitformis linked to?
Coeliac disease
94
One single ring enhancing lesion on CT Brain?
Abscess
95
Abx for brain abscess?
Ceftriaxone + metronidazole
96
What is lead time bias?
new investigation method diagnoses early but no effect on outcome
97
Perioxisomes action?
catabolism of long chain fatty acids
98
What are the indications for steroids in sarcoidosis?
parenchymal lung disease, uveitis, hypercalcaemia, neuro/ cardiac involvement.
99
Anti Hu antibodies seen in and with what?
Small cell lung cancer Painful sensory neuropathy Cerebellar syndrome
100
Stain and sign for Cryptosporidium?
modified ZN stain - red cysts
101
What is Kartanger syndrome?
primary ciliary dyskinesia
102
How is kartanger syndrome seen?
Dextrocardia, chronic sinusitis, bronchiectasis, male sub fertility
103
Renal complication of Tuberous sclerosis?
renal angiomyolipomata prone to haemorrhage
104
ABG seen in Cushings?
hypokalaemic metabolic alkalosis, due to sodium and water retention
105
Causes of Eczema herpeticum?
HSV Cocksakie virus
106
Action of Secretin?
Secretin promotes bicarbonate secretion in GIT
107
What causes cat scratch disease?
Bartonella
108
Staining in cat scratch disease?
Wartharin-starry staining
109
Presentation of cat scratch disease?
regional ipsilateral lymphadenopathy
110
High C-peptide?
High c-peptide endogenous insulin
111
Low C-peptide?
Low c-peptide means insulin exogenous
112
What is Pulsus alternans?
alternating strong and weak pulse in severe LVF
113
What is Pulsus paradoxes?
fall of BP on inspiration in cardiac tamponade
114
How do you treat Adrenaline induced ischaemia?
phentolamine
115
What is the mechanism of action of Timolol?
Timolol reduces aqueous production in open angle closure glaucoma
116
What can Polycyanthemia Vera progress to?
AML
117
Mode of inheritance of Peutz-jeghers syndrome?
AD
118
What is Peutz-jeghers syndrome?
AD haemartomas in GIT leading to colon cancer seen with pigmented freckles on lips, face, palms
119
Malaria with shortest erythrocytic replication cycle leading to high parasite count in short period of time
plasmodium knowlesi
120
Dermatomyositis most common antibody?
ANA
121
Dermatomyositis most specific antibody?
Anti Mi 2 Or Anti Jo-1
122
Which anti malarial to avoid in G6PD?
Primaquine avoid in G6PD
123
Treatment of oculogyric crisis?
Procyclidine
124
What is 11-beta hydroxylase deficiency?
congenital adrenal hyperplasia with excess DOC
125
What is 11-beta hydroxylase deficiency associated with hypertension/ normotension?
Hypertension HypoK
126
What is Wiskott-Aldrich syndrome?
Combined B- and T-cell disorders
127
What produced gastrin?
G cells in antrum of stomach
128
Stroke of anterior cerebellar artery?
Contra-lateral hemiparesis Sensory loss Lower limb > upper
129
Stroke of middle cerebral artery?
Contra-lateral hemiparesis sensory loss Upper > lower Homonymous hemianopia Aphasia
130
Posterior cerebellar artery stroke?
Contra-lateral homonymous hemianopia with macular sparing Visual agnosia
131
Webers syndrome?
Stroke of branch of posterior cerebral artery supplying the midbrain
132
Weber's syndrome presentation?
Ipsilateral CN palsy Contra-lateral weakness in upper and lower limbs `
133
Posterior inferior cerebellar artery stroke AKA?
Wallenberg syndrome Lateral medullary syndrome
134
What is wallenberg syndrome?
Ipsilateral facial pain and temp loss Contralateral limb/ torso pain and temp loss Ataxia and nystagmus
135
Anterior inferior cerebellar (lateral pontine syndrome) signs?
Ipsilateral facial paralysis Deafness
136
India ink for?
Cryptococcal
137
Reduce risk of calcium renal stones medication?
Thiazides
138
MRI head non enhancing multiple lesions?
JC virus
139
Primary central nervous system lymphoma on MRI?
HIV CD4 <50 multiple enhancing lesions with oedema and mass effect
140
Hazard ratio meaning?
Analysing survival over time
141
Action of Buprenoprhine?
partial agonist of the mu-opioid receptor and an antagonist of the kappa-opioid receptor
142
What is De Quervains tenosynovitis?
inflammation of the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons
143
What is a nonsense mutation?
A mutation that results in a stop codon
144
Ticagrelor mode of action?
Inhibits ADP binding of platelet receptors
145
Donepezil SE?
Insomnia
146
Pre diabetes diagnosis?
fasting 6.1-6.9 HbA1c 42-47
147
Impaired fasting glucose?
6.1 to <7
148
Impaired glucose tolerance?
Fasting <7 and OGTT 7.8+ <11.1
149
Cavitating lung cancer?
Squamous cell
150
Management of bleeding in VWF?
Desmopressin
151
Livedo reticularis rash (lace like) in?
SLE Cryoglobulinaemia Anti phospholipid Ehlers-Danlos syndrome
152
Muddy brown casts?
ATN
153
Ankylosing spondylitis x-ray?
Syndesmophytes
154
Von Hippel Lindau syndrome renal cancer?
Clear cell renal cell carcinoma
155
What is leptin?
Produced by adipose tissue and decreases appetite
156
Length for result of finasteride?
6 months
157
Staph aureus time to food poisoning?
4 hours
158
What does lichen planus look like?
P's on flexors Planus Purple Pruritic papular Polygonal + wickmans striae
159
Best data class- meta analysis?
1a
160
Dermatitis herpitformis and Sjogrens HLA?
HLA DR3
161
Behcets HLA?
HLA B51
162
T1DM HLA?
HLA DR4
163
Allergic bronchopulmonary aspergillosis tx?
Prednisolone
164
Rapid depolarisation cause?
Rapid sodium influx
165
Opioid for renal impairment?
Buprenoprhine
166
What is Trastuzumab?
Herceptin
167
What is the mode of action of herceptin/ trastuzumab?
HER2
168
Selegiline mode of action?
MAO-B inhibitor
169
LRTI with hypoNa?
Legionella
170
Ciclosporin levels timing?
Immediately before next dose
171
3 Anti HTN, K for next step?
>4.5
172
3 anti HTN with K 4.6 next step?
Alpha blocker Beta blocker
173
3 anti HTN with K 2.1?
Spironolactone
174
Bladder calcification?
Schistosoma haematobium
175
Rosacea treatment?
Topical ivermectin + oral doxycline
176
Source of folic acid?
Liver
177
S4?
Aortic stenosis HOCM
178
S3?
Normal <30 LVF (dilated cardiomyopathy), MR, constrictive pericarditis
179
HIV linked to obstructive jaundice cause?
Sclerosing cholangitis
180
SE of hydroxychloroquine and monitoring as a result?
Retinopathy Fundoscopy and VA
181
DiGeorge syndrome as defective?
T cells
182
Infection risk in DiGeorge?
Cryptococcus neoformans due to thymus hypoplasia
183
What is osteomalacia?
Vit D deficiency of adults Low Ca and phosphate High PTH Looser zones
184
What is pagets?
Increased bone turnover Isolated raised ALP
185
Drugs causing gingival hyperplasia?
Gums - gingival hyperplasia Can- CCB (amlodipine, nifidipine) Cause- Cyclosporin Pain - Phenytoin Alot- AML
186
Skin cancer in renal transplant?
SCC
187
Bicuspid aortic valve is associated with?
Coarctation of the aorta
188
Renal stones are most commonly?
Calcium oxalate
189
Pulmonary haemorrhage and nephritic syndrome think?
Goodpastures syndrome
190
What is good pastures syndrome?
anti GBM
191
Hereditary angioedema due to?
Bradykinin
192
Biopsy with subepithelial deposits, thickened capillary walls and nephrotic syndrome?
Membranous glomerulnephritis
193
Bladder cancer infection?
Schistosomiasis
194
Nasopharyngeal cancer linked to?
EBV
195
Stage 1 diabetic nephropathy?
Hyperfiltration and increase in eGFR
196
Stage 2 diabetic nephropathy?
eGFR elevated and latent
197
Stage 3 diabetic nephropathy?
Microalbuminuria
198
Stage 4 diabetic nephropathy?
Proteinuria >300 with diffuse glomerulsclerosis, and kimmelsteil wilson nodules
199
Stage 5 diabetic nephropathy?
ESRD
200
Epsilon waves in V1-3?
Arrthymogenic right ventricular cardiomyopathy (ARVD)
201
What is arrthymogenic right ventricular cardiomyopathy?
Replacement of R ventricle with fatty fibrous tissue
202
Risk of atypical anti psychotics in elderly?
VTE
203
Lights criteria for exudative effussion?
High protein/ serum protein >0.5 Fluid LDH / serum LDH >0.6 Fluid LDH > 3* normal
204
CRAB + raynauds seen in?
Type 1 cryoglobulinaemia
205
What is the action of troponin C?
Binding calcium to activate muscle contraction
206
Avascular necrosis of hip seen more in?
Chronic alcoholics
207
Primary biliary sclerosis linked to?
Sjrogens
208
Treatment of PBS?
Ursodeoxycholic acid
209
Features of ankylosing spondylititis?
A's - Apical fibrosis - Anterior uveitis - Aortic regurgitation - Achilles tendonitis - AV node block - Amyloidosis
210
Which abx can prolong QTc?
Erythromycin
211
Eggshell calcification on scans in lung?
Silicosis (miners lung)
212
Miners lung is?
Silicosis
213
How do you calculate standard error of the mean?
SD / square root (no. pt)
214
Ashoff bodies seen in?
Rheumatic fever
215
What are ashoff bodies?
Granulomatous nodules in rheumatic fever
216
What is high ASOT?
Rheumatic fever
217
Infliximab action?
Anti TNF
218
Action of flecanide?
Blocks Na v 1.5 channels in the heart
219
What is associated with MALT lymphoma?
hashimotos thyroiditis
220
Hypothyroidism adjustment in pregnancy?
Increase up to 50%
221
Most common inherited thrombophilia?
Factor V leiden
222
How is Lesch-Nyhan syndrome passed on?
X linked recessive
223
How is lesch-nyhan seen?
Sand coloured, orange stools Hyperuricaemia
224
Thrombectomy in stroke?
6-12 hours
225
Thrombolysis for stroke?
4.5h
226
Dentistry in warfarinised patients?
Check INR 72 hours before, proceed if <4
227
Good prognosis in GBS?
No diarrhoeal illness
228
Poor prognosis in GBS?
Anti GM1 high
229
X-ray findings of ankylosing spondylitits?
Syndesmophytes, subchondral erosions, sqauring of vertebrae
230
Mechanism of action of aspirin?
Inhibits thromboxane A2 production
231
Severe malaria?
Parastaemia >2%
232
Canon A waves JVP?
Complete heart block
233
Last stage of atherosclerotic plaque?
Smooth muscle proliferation and migration from media to intima
234
Screening for herediatry angioedema between attacks?
C4
235
Mechanism of action of aspirin?
Non reversible COX 1 and 2 inhibitor
236
Mechanism of action of docetaxel?
Prevents microtubule depolymerisation and dissasembly
237
Mechanism of action of buprenoprhine?
Partial agonist Mu- opioid receptors Antagonism at kappa
238
Sitagliptin is a?
DDP-4 inhibitor
239
Effect of DDP-4 inhibitors e.g., sitagliptin on weight?
DONT cause weight gain
240
Haemolytic uremic syndrome triad?
- Haemolytic anaemia (MAHA) - AKI - Thrombocytopenia
241
Causes of cranial DI?
Head injury Pituitary surgery Craniopharyngiomas Sarcoidosis Histiocytosis X Hemochromatosis
242
Causes of nephrogenic DI?
Vasopressin receptor deficiency Less common aqauporin 2 channel HyperCa HypoK Lithium
243
Tetracyclines can cause what SE?
Photosensitive rash to face and neck
244
Crohn's signs?
Inflammation of all layers Goblet cells granulomas Rose thorn ulcers Kantors string sign
245
What is kantors string sign?
Strictures in Crohn's
246
Crypt abscesses, pseudopolyps, depletion of goblet cells are seen in?
UC
247
Motion sickness treatment?
Hyoscine Cyclizine Promethazine
248
What coronary artery supplies the AVN?
RCA
249
What is the mode of action of spironolactone?
Collecting ducts
250
Cisplatin can cause renal dysfunction via?
ATN from direct nephrotoxicity
251
Very low CSF glucose in meningitis with viral signs?
mumps
252
Treatment of pulmonary HTN with response to vasodilators (IV nitric oxide)?
CCB- nifidipine
253
What causes Graves Disease?
igG antibodies to TSH receptors
254
SBP diagnosis?
Neutrophils in fluid >250
255
Bergers disease is?
IgA nephropathy seen as visible haematuria following URTI and hypertension
256
Bergers disease poor prognosis>
HTN
257
Right sided murmurs loudest on?
Inspiration
258
Immune cells bind to which part of antibodies?
Fc region
259
Multiple cysts in the liver with travel to India?
Hydatid cysts
260
What causes hydatid cysts?
Echinococcus granulosus
261
Management of hydatid cysts?
Surgery ensuring not to rupture
262
Alcohol binge causes polyuria by?
ADH inhibition
263
Non caseating granulomas are seen in?
Crohn's not UC
264
Avoid donepezil in?
Bradycardia
265
How to remember sensory of hand?
L hand make a 6 Thumb first finger C6 then middle C7 Ring and little C8
266
Plt transfusion carries higher risk of?
Bacterial infection
267
How does pellagra present?
Dermatitis Diarrhoea Dementia
268
What is pellegra?
Niacin deficiency
269
What is porphyria cutanea tarda?
Photosensitive rash Blistering and skin fragility Face and dorsum of hands
270
Meningitis with parkinsonian signs?
Japanese encephalitis
271
Cause of upbeat nystagmus?
Cerebellar vermis lesions
272
Cause of downbeat nystagmus?
Arnold-Chiari malformation
273
Phenytoin can cause?
Gynaecomastia
274
P450 inducers:
Smoking Phenytoin Carbamazepine Rifampicin St Johns Wort Chronic alcohol
275
P450 inhibitors:
Ciprofloxacin Erythromycin Isoniazid Amiodarone -Azoles SSRIs Sodium valproate
276
What causes a +ve cyanide-nitroprusside test?
Cystinuria
277
What is cystinuria?
AR recurrent renal stones due to COLA defect
278
Live vaccines how long apart?
4 weeks
279
Subacute thyroiditis seen as?
Tender goitre Hyperthroidism Raised ESR Reduced uptake techneticum scan
280
Essential tremor inhertiance?
AD
281
What can worsen absence seizures?
Carbemazepine
282
ethosuximide in breast feeding?
Avoid due to sedation
283
Lamotrigine and breast feeding?
Safe
284
A wave of JVP
Atrial contraction
285
Absent A wave in JVP?
AF
286
C wave of JVP?
Closure of tricuspid valve
287
V wave in JVP?
Passive filling of blood in atrium against closed tricuspid valve
288
x descent JVP?
Ventricular systole
289
Y descent?
Opening of tricuspid valve
290
Which BRCA gene is associated with prostate cancer?
BRCA2
291
SGLT-2 inhibitor's example?
Goes Loo toilet Empagliflozin Glucose excretion
292
DDP4-i example?
P looks like a lip Linagliptin
293
T2DM management?
Metformin or MR + SGLT2-inhibitor (CVD, QRISK >10) + DDP-4 inhibitor + SU/ Pioglitazone - GLP-1 mimetic BMI >35 or insulin
294
Avoid what medications in HOCM?
Ramipril
295
Electrolyte disturbance in QTC prolongation?
Hypocalcaemia
296
Inferior MI can lead to?
AV block
297
What does insulin bind to?
Tyrosine kinase receptor in cell membrane
298
Mechanism of action of digoxin?
Inhibits Na/K ATPase pump
299
Gliclazide is a?
SU
300
Gliclazide a SU causes?
Weight gain Hypoglycaemia HypoNa
301
SGLT2 inhibitors e.g., gliflozins SE?
Euglycaemic ketosacidosis UTIs Forniers gangrene
302
Congenital toxoplasmosis is seen as?
Cerebral calcifications Chorioretinitis
303
Bupropion for smoking cessation can cause GTCS by what mechanism?
Inhibition of norepinephrine-dopamine reuptake and antagonism of nicotinic ACh receptors
304
Winging of scapula in muscular dystrophy?
Facioscapulohumeral muscular dystrophy
305
Facioscapulohumeral muscular dystrophy inheritance?
AD
306
Diffuse systemic sclerosis most specific antibody?
Anti Scl-70
307
Antibodies for Idiopathic membranous glomerulonephritis?
anti-phospholipase A2 antibodies
308
History of anaphylaxis test?
RAST
309
Non arteritic anterior ischaemic optic neuropathy (NAION) seen as?
Swollen pale disc and blurred margins
310
Acyclovir mode of action?
Inhibits DNA polymerase
311
Test for Zollinger-Ellison syndrome?
Secretin stimulation test- causing increase in gastrin
312
What is valency?
Number of distinct serotypes a vaccine can protect against
313
When do you give ciprofloxacin prophylaxis for SBP?
Ascites protein < or equal 15
314
Porphyria Cutanea Tarda cause?
Uroporphyrinogen decarboxylase deficiency
315
Acute intermittent porphyria cause?
Porphobilinogen deaminase
316
What complications of haemochromatosis are reversible with treatment?
Cardiomyopathy and skin pigmentation
317
Hypertensive retinopathy stages 1-4?
1- narrowing 2- AV nipping 3- cotton-wool spots, haemorrhages 4- papilledema
318
Chemotherapy leading to hypoMg?
Cisplatin
319
DVLA advice post multiple TIAs?
No driving 3 months
320
Double duct sign?
Pancreatic head carcinoma
321
Treatment of visceral lesishmaniasis?
Sodium stibugluconate
322
Loud S2
Pulmonary HTN
323
Carcinoid test for diagnosis?
Urinary 5-HIAA
324
Where is the medial longitudinal fasciculus (affected in internuclear ophthalmoplegia)?
Paramedian area of midbrain and pons
325
Bisferiens pulse AKA double pulse seen in?
Mixed aortic valve disease, HOCM
326
Osteogenesis imperfecta is a abnormally synthesized collagen of which type?
1
327
Passing emboli with DVT to stroke heart defect?
ASD- most commonly patent foramen ovale
328
Temporal lobes contain the?
Wernickes area
329
Oxygen dissociation curve shift?
shifts Left - Lower oxygen delivery - Lower acidity, temp, 2-3 DPG - also HbF, carboxy/methaemoglobin shifts Right - Raised oxygen delivery - Raised acidity, temp, 2-3 DPG
330
How to calculate NNT?
1-ARR
331
People with allergy to aspirin may react to which DMARD?
Sulfasalazine
332
Smoking in UC?
Protective
333
Treatment of methanol poisoning?
Fomepizole
334
Action of fomepizole (tx methanol poisoning)?
Competitive inhibition of alcohol dehydrogenase
335
Next step if angina not controlled by BB?
+ Amlodipine
336
Short PR interval?
Wolff-Parkinson White syndrome
337
Causes of prolonged PR interval?
IHD Digoxin toxicity HypoK Rheumatic fever Aortic root abscess Lyme disease Sarcoidosis Myotonic dystrophy
338
Neisseria meningitides gram stain?
Gram negative cocci
339
MODY treatment?
SU Gliclazide
340
Most common adult viral meningitis?
Cocksakie virus B
341
Brittle asthma with brown sputum and high eosinophils think?
Allergic bronchopulmonary aspergillosis
342
Drug induced cholestasis?
COCP
343
Prominent V waves on JVP?
Tricuspid regurgitation
344
What does the golgi add to proteins for trafficking to lysosomes?
Mannose-6-phosphate
345
G1 phase determines?
Cell length associated with p53
346
Histology of IgA nephropathy?
Mesangial hypercellularity IgA C3
347
SGLT2 works in the?
PCT
348
SU acts on the?
beta cells
349
Action of Anastrozole?
Aromatase inhibitor
350
Lofepramine is a?
TCA
351
Normovolaemic hypoNa drug causes?
TCA Carbmazepine SU SSRIs
352
Thin blood film determines?
Speciation
353
Thick blood film determines?
parasite burden
354
What is a leukaemoid reaction?
Immature cells due to severe infection/ haemolysis/ haemorrhage
355
Dohle bodies in white cells?
Leukaemoid reaction High Leukocyte ALP score
356
What is Lofgren's syndrome?
Acute sarcoidosis: - Erythema nodosum - Bilateral hilar lymphadenopathy - Polyarteritis
357
Treatment of pulmonary HTN?
+ve response vasodilators = CCB -ve result to vasodilators = iloprost Sildenafil
358
How does NAC work?
Replenishes glutathione
359
Immunoglobulins in autoimmune hepatitis?
IgG
360
What is whipples disease?
tropheryma whipplei infection
361
PAS staining granules seen in?
Whipples disease
362
Pneumonia with cold sores?
Strep pnuemonia
363
Sickle cell long term crisis prevention?
Hydroxycarbamide
364
Acoustic neuromas seen as?
Dizziness Hearing loss Loss of corneal reflex as compresses trigeminal nerve
365
Medication induced tinnitus?
Quinine
366
Haloperidol blocks?
D2 antagonist
367
Cause of Erysipelas?
Strep pyogens
368
SLE complement low?
C4
369
Cant take triptans with?
SSRI due to increased risk of serotonin syndrome
370
QT interval and calcium?
Hyper - shorts Hypo- prolongs
371
Ehlers-Danlos collagen affected?
Collagen type 3
372
Driving post ICD insertion?
1 week
373
Ann Arbour staging?
I- single LN region II- 2+ regions on same side III- nodes on both sides IV- beyond lymph nodes
374
HIV and nephrotic syndrome?
FSGS
375
Poor shoulder external rotation?
Adhesive capsulitis
376
Bullous pemphegoid biopsy?
IgG and C3 at dermoepidermal junction
377
Strep sanguini/mitis IE check up?
Dental review
378
Strep gallotyticus IE cause?
Bovis colorectal cancer
379
Reactive arthritis organism?
No organism in fluid Chlamydia
380
Eczema herpeticum infection cause?
HSV 1 +2
381
IE <2 months post replacement?
Staph epidermidis
382
Most common cause of IE?
Staph aureus
383
Renin in renal artery stenosis and Conns?
Conns LOW RAS HIGH
384
In MI due to cocaine also give?
IV lorazepam
385
Action of bisphosphonates?
Inhibits osteoclasts
386
Secretin is secreted from?
S cells in small intestine
387
Test for HIV when query of seroconversion illness?
p24 antigen test
388
Myoclonic seizures treatment in males?
Sodium valproate
389
Monoclonal antibody used to prevent recurrence of C. diff in high risk?
Bezlotoxumab
390
What is miller-Fisher variant?
GBS variant affecting CN first, often eyesight, and preceded by infection
391
Conversion disorder is?
FND loss of motor or sensory function
392
Thiazides act at the?
Proximal DCT
393
Damage to what area causes hemiballismus?
Subthalamic nucleus
394
Causes of pseudogout?
Haemachromatosis Low Mg Low PO42- Acromegaly Hyperparathyroidism
395
Early RA finding on x-ray?
Juxta-articular osteoporosis
396
What is the power of a study?
1 - the probability of a type II error (correctly rejecting the null hypothesis)
397
Causes of tunnel vision?
papilloedema glaucoma retinitis pigmentosa choroidoretinitis optic atrophy secondary to tabes dorsalis
398
Pleural effussion caused by hypothyroidism?
Transudative
399
Cherry red lung lesion?
carcinoid
400
First line for secretions in palliative care?
Hyoscine butlbromide
401
Typhoid rash?
Rose spots, salmon macules on trunk and abdomen
402
Typhoid fever can cause HR to?
Relative bradycardia
403
HIV and breastfeeding?
NO
404
Anti-RNP?
Mixed connective tissue disease
405
What activates macrophages?
Interferon-y
406
Most common SLE renal disease?
Diffuse proliferative glomerulonephritis
407
Restless leg syndrome blood test?
ferritin
408
Hunger controlled by which brain region?
Ventromedial area of hypothalamus
409
What is Fanconi syndrome?
Reabsorptive defect in PCT with excretion of amino acids, glucose, bicarbonate + phosphate
410
Haemophilia A inheritance?
X linked recessive
411
In X linked recessive conditions who cant transmit?
Male to male
412
What complement deficiency predisposes you to Neisseria meningitidis infection?
C5-9 deficiency
413
What is phase 1 drug metabolism?
Oxidation Reduction Hydrolysis
414
What is phase 2 drug metabolism?
Conjugation
415
What is cardiac syndrome X?
Microvascular angina with down sloping ST depression
416
Coeliac HLA?
HLA- DQ2
417
Causes of raised TLCO?
Asthma Pulmonary haemorrhage L-R cardiac shunts Polycythaemia
418
Causes of lower TLCO?
Fibrosis Pneumonia PE Oedema Emphysema Anaemia Low cardiac output
419
What is KCO?
Transfer coefficient (corrected for lung volume)
420
Reduced TLCO but increased KCO?
Pneumonectomy Scoliosis NM weakness Ankylosing spondylitis
421
Loud S2?
Hypertension
422
Soft S2?
AS
423
Fixed split S2?
ASD
424
Reversed split S2?
LBBB, severe AS
425
Skewed distributions?
Mean - Median - Mode
426
Uric acid stones are?
Radiolucent
427
IBS treatment?
Antispasmodic + laxative (not lactulose), loperamide + linaclotide laxative + amitriptyline
428
Test to look for mutations?
PCR
429
Cause of acute epiglottitis?
Haemophilus influenzae type B
430
Hereditary spherocytosis test?
EMA binding test
431
Most important HLA matching in renal transplant?
DR
432
Match for HLA for long term graft survival?
A
433
Primary hyperparathyroidism?
High or normal PTH Hypercalcaemia
434
Secondary hyperparathyroidism?
High PTH in response to hypocalcaemia Secondary to Vit D deficiency or renal failure
435
Tertiary hyperparathyroidism?
Prolonged secondary with high PTH and normal calcium
436
Management of drug induced parkinsons if medication cant be stopped?
Benzhexol/ trihexyphenidyl
437
Most common organism in bronchiectasis?
Haemophilus influenzae
438
Following bells palsy patients may complain of?
Hyperacusis (sensitivity to sound due to facial nerve innervating stapedius)
439
Does coal dust lead to lung cancer?
NO
440
SE of magnesium sulphate?
Respiratory depression Reflexes Oxygen saturations
441
Reversal of Mg sulphate respiratory depression?
Calcium gluconate
442
Normal pO2 but decreased oxygen saturations?
Methaemoglobinaemia
443
Mutation in p53 gene name?
Li-fraumeni syndrome
444
Inheritance of Li-Fraumeni syndrome?
AD
445
Cancers of Li-Fraumeni syndrome (p53 mutation)?
Breast cancer Sarcoma Leukaemia
446
Poor repetition aphasia?
Conduction dysphasia
447
What is expressive dysphagia?
Non fluent and halting
448
What is receptive dysphasia?
Fluid but incomprehensible
449
Hereditary spherocytosis crisis management?
IVF and high dose folic acid Transfusion if symptomatic of anaemia
450
Tumour lysis syndrome treatment?
Rasburicase and IVF
451
Warm haemolytic anaemia can be caused by?
Non Hodgkin's lymphoma CLL
452
Psoriasis treatment?
Emollient Topical steroid Topical calcipotriol
453
PBC Ig raised?
IgM
454
Driving following unprovoked seizure with normal imaging?
6 months
455
Driving advice after seizure with imaging changes?
12 months
456
VSD murmur?
Holosytolic, harsh murmur
457
PDA murmur?
Continuous machinery murmur
458
Collapsing pulse?
MR PDA
459
Digoxin toxicity ECG changes?
ST depression Short QT Inverted T Prolonged PR
460
Hypokalaemia ECG?
Prolonged PR Long QT ST depression U waves
461
Action of flecanide?
Blocks Na channels prolonging rapid depolarisation (phase 0)
462
How does amiodarone work?
Blocks voltage gated K channels, delaying repolarisation
463
Ablation for AF location?
Between pulmonary veins and L atrium
464
Ablation for atrial flutter location?
Cavotricuspid isthmus
465
Broad complex tachycardia ms?
>120ms
466
Inherited causes of TdP?
Romano-Ward and Jervell Lange- Nielson syndrome
467
Acquired causes of TdP?
TIMES Toxins: clarithromycin, TCA, anti arrythmics, anti psychotics, SSRIs Ischaemia Myocarditis Electrolytes: hypo K, Mg, Ca SAH
468
Congenital TdP prevention?
BB
469
ECG osbourne waves?
Hypothermia
470
How to control BP in dissection?
IV metoprolol
471
What is Heydes syndrome?
Complication of AS with depletion of VWF-2a causing GI bleed and angiodysplasia with ID
472
Severe AS classification:
Peak gradient >40 Valve area <1 Jet velocity >4 Clinical absent S2
473
Medical management of HF?
ACEi + BB
474
When is surgical intervention needed for AS?
Symptomatic LVEF <50 LVEF >50 but fall in BP on exercise testing Severe pulmonary HTN >60
475
LVH on ECG?
P Mitrale
476
Mitral stenosis of hoarseness due to compression of recurent laryngeal nerve?
Ortner's syndrome
477
What is Ebsteins anomaly?
R sided HF in young due to structurally abnormal tricuspid valve (TR)
478
Cause of rheumatic fever?
Group A beta haemolytic strep (scarlet fever)
479
Signs of rheumatic fever?
Arthritis Sydenhams chorea Erythema marginatum SC nodules
480
Treatment of rheumatic fever?
STAT Benzylpenicillin 10 days phenoxymethylpenicillin
481
Most common valve problem in rheumatic fever?
MS
482
Becks triad and what for?
Cardiac tamponade Hypotension Quiet heart sounds Raised JVP
483
Pulsus paradoxus?
Cardiac tamponade
484
Takotsubo cardiomyopathy?
Stress induced transient apical ballooning ST elevation with trop rise but normal angiogram
485
ARVC?
AD fatty fibrous replacement of myocardium showing hypokinetic segment on R ventricle
486
Dilated cardiomyopathy HF?
HFrEF
487
Causes of dilated cardiomyopathy?
Toxins Cocksakie B Haemochromatosis Amyloidosis Sarcoidosis Wet beri beri (thiamine def)
488
What causes hypertrophic cardiomyopathy?
AD mutation in sarcomeres leading to LVH
489
Diagnostic ECHO findings of hypertrophic cardiomyopathy?
MR SAM ASH Mitral regurgitation Systolic anterior motion of MV leaflets Asymmetrical septal hypertrophy
490
Treatment of hypertrophic cardiomyopathy?
BB
491
Most common cause of ASD?
patent foramen ovale
492
EF for rEF?
<40%
493
Normal EF?
50-70%
494
Mortality benefit in HF?
BB ACEi Spironolactone Hydralazine
495
HF medical management:
ACE-i (or ARB) + BB (or hydralazine) start one at a time Symptoms persisting: + Spironolactone (eplerenone) + Ivabradine, digoxin, hydralazine
496
Angina treatment?
BB or verapamil BB + amlodipine/ MR nifedipine Or long acting nitrate, Ivabradine, Nicorandil Secondary prevention: Statin 80, aspirin 75
497
Persistent ST elevation?
Left ventricular aneurysm
498
Management of Dresselers syndrome?
High dose aspirin
499
How is a cholesterol emboli seen?
Renal failure Eosinophilia Livedo rectularis After cardiac catherization commonly
500
What is wellen syndrome?
Deeply inverted or biphasic T waves in V2-3 showing LAD stenosis
501
Incomplete BBB?
QRS 110-120ms
502
Most specific for pericarditis?
PR depression
503
P pulmonale is?
R atrial enlargement
504
Pulmonary HTN diagnosis?
R heart catherization with Mean PAP >25
505
What is brugada syndrome?
AD Na channelopathy seen with coved ST elevation of >2mm in >1 V1-3 followed by T wave inversion
506
Treatment of brugada syndrome?
ICD
507
Mechanism of action of digoxin?
Na/K ATPase inhibitor Parasympathetic to SAN (positively inotropic, negatives chronotropic)
508
ECG changes in digoxin toxicity?
Reverse Tick sign Down sloping ST depression
509
Location of cardiac myxoma?
L atrium
510
Methadone overdose can cause cardiac arrest by?
QT prolongation
511
Action of loop diuretics (furosemide, bumetanide)?
Ascending loop and Henle
512
Avoid which medications in HOCM?
ACEi
513
Brugada mutation gene?
SCN5A gene
514
Prinzmetal angina management?
CCB felodipine
515
Egg on a string heart appearance?
Transposition of the great arteries
516
What causes transposition of the great arteries?
Failure of the aorticopulmonary septum to spiral
517
What is the mechanism of action of dipyridamole?
Phosphodiesterase inhibitor decreasing cellular uptake of adenosine
518
Antithrombotic to be started in bioprostehtic heart valves?
Aspirin
519
Antithrombotics to be started in mechanical heart valves?
Warfarin + aspirin
520
Poor prognosis in HOCM?
Septal wall thickness >3cm
521
Predicting response to cardiac resynchronisation therapy?
ECG - LBBB TTE
522
Inherited long QTc and sensorineural deafness?
Jervell and Lange-Nielsen syndrome
523
Strongest risk factor for IE?
Previous IE
524
What is the mode of action of nicorandil?
K channel activator
525
After electrical cardioversion for AF how long should anticoag be continued for?
4 weeks
526
PET scans use?
Fluorodeoxyglucose
527
Check U+E before starting amiodarone to detect?
HypoK
528
ACEi cough due to increased?
Bradykinin
529
Valsalval maneourve causes?
reduced venous return
530
Good prognosis in IE?
Strep viridans
531
Why does long QT syndrome occur?
Blockage of K channels
532
Streptococcus viridans abx?
IV benpen
533
Treatment of prolactinoma?
- Cabergoline (bromocriptine if pregnant) - If medical management fails = surgery
534
Cushing disease is a?
Pituitary adenoma
535
Diagnosis of cushings disease?
High dose dexamethasone suppression test
536
Diagnosis of cushings syndrome?
Low dose dexamethasone suppression test
537
Is cushing syndromes cortisol suppressed by low dose dexamethasone suppression test?
No
538
Cortisol and ACTH following high dose dexamethasone suppression test?
Cushing disease: low cortisol, low ACTH Ectopic ACTH: high cortisol, high ACTH Cushing syndrome: high cortisone, low ACTH
539
If surgery not an option for Cushing's disease give?
Metyrapone
540
Screening for acromegaly?
IGF-1
541
Diagnosis of acromegaly?
OGTT
542
FU for acromegaly?
Colonoscopy ECHO
543
Action of ADH?
upregulating aquaporin-2 channels to collecting ducts concentrating urine
544
Causes of SIADH?
- Pituitary adenoma - SCLC production - Meningitis, CNS tumours, intracranial haemorrhage - SSRIs, tricyclics, carbamazepine
545
Emergency management of hypoNa?
150ml 3% NaCl bolus
546
SIADH managemet?
Correct cause FR 750ml If ineffective domeclocycline
547
Diabetes insipidius AKA arginine vasopressin disorder is?
Too little ADH
548
Diagnosis of Diabetes insipidus (arginine vasopressin disorder)?
Fluid deprivation test 8h Synthetic ADH (desmopressin)
549
Adrenal hormones layers:
G Aldosterone F Cortisol R Androgens Medulla adrenaline/ nor
550
Antibodies associated with Addisons?
adrenal cortex antibodies 21-hydroxylase antibodies
551
Diagnosis of addisons?
Short Synacthen test
552
Action of aldosterone?
Na reabsorption K and H secretion At DCT
553
Radioidone number?
I-131
554
Who cant have radioiodine?
Pregnant or breast feeding Worsens thyroid eye disease
555
How long to wait to conceive after radioiodine?
Women 6 months Man 4 months
556
Management of thyrotoxic storm?
Propylthiouracil Propranolol Steroids Prednisolone Cooling
557
Affect of amiodarone on thyroid?
Mostly hypothyroidism (AIH) via Wolff-Chiakoff effect Can cause AIT thyrotoxicosis- stop
558
AIT type 1?
Goitre treat with carbimazole
559
AIT Type 2
Corticosteroids
560
Antibodies in hashimotos thyroiditis?
Anti TPO Anti Thyroglobulin Anti TSH receptor
561
What is De Quervains thyroiditis?
Self limiting painful goitre after URTI
562
Papillary adenocarcinoma of thyroid?
Thyroglobulin tumour maker Orphan annie nuclei Psommoma bodies
563
Follicular adenocarcinoma of thyroid?
Thyroglobulin tumour marker Hurthle cell change (follic hurt)
564
Poor prognosis thyroid cancer?
Anaplastic/ undifferentiated
565
Medullary carcinoma of thyroid?
CEA and calcitonin markers Electron dense granules
566
Rickets sign?
Cupping and splaying of metaphyses Rosary sign
567
What is Phaeochromocytoma?
Adrenal medulla tumour (chromaffin cells) secreting catecholamines
568
3 genetic conditions linked to phaeochromocytoma?
MEN 2 NF 1 Von Hippel Lindau
569
Test for phaeochromocytoma?
24 hr urinary collection of metanephrines
570
Management of phaeochromocytoma?
Alpha blockade- phenoxybenzamine Then propranolol
571
MEN 1:
3 P's Pituitary adenoma Parathyroid hyperplasia Pancreas MEN1 gene AD
572
MEN 2a:
Parathyroid hyperplasia Medullary carcinoma Phaeochromocytoma RET gene AD
573
MEN 2b:
Medullary carcinoma Phaeochromocytoma Mucosal neuromas Marfanoid RET gene AD
574
Which cancer can cause hyperparathyroidism?
Sqaumous cell lung ca with PTHrP
575
Which hormones can sqaumous cell lung cancer secrete?
PTHrP b-HCG
576
Which lung cancer can cause SIADH and cushings?
Small cell lung cancer
577
MODY 3 mutation?
HNF1A
578
MODY 3 BM and management?
HIGH BM SU
579
MODY 2 management?
Diet
580
Contraindications to metformin?
eGFR <30 Serum creat >150
581
Pioglitazone SE?
Water retention- not in HF Bladder cancer
582
HHS definition?
BM 30+ Without ketones <3 or acidosis pH >7.3/bicarb >15 Osmolality 320+
583
How do you calculate osmolality?
2Na + glucose + urea
584
Response to HHS treatment?
Decrease in BM 5 an hour if not sliding scale
585
When does glucagon not work?
Starved/ cachectic Alcohol
586
What are porphyrias?
Enzyme deficiencies in the haem synthesis pathway
587
Complication of porphyrias?
HCC
588
3 types of porphyria?
AIP- acute intermittent AD PCT- Porphyria cutanea tarda Variegate AD
589
Defect in AIP- acute intermittent porphyria?
Porphobilinogen deaminase Urine red in light
590
PCT- porphyria cutanea tarda seen as?
pink urine under woods lamp Photosensitive blistering rash
591
Defect in PCT, porphyria cutanea tarda?
Uroporphyrinogen decarboxylase
592
Variegate porphyria presentation?
Blistering photosensitive rash with abdo/ neuro involvement
593
Defect in variegate porpohyria?
Protoporphyrinogen oxidase
594
PCOS blood tests?
LH:FSH ratio >2 Normal FSH SHBG low
595
Cause of impaired fasting glucose?
Hepatic insulin resistance
596
Causes of raised prolactin?
p's: pregnancy prolactinoma PCOS primary hypothyroidism phenothiazines, metoclopramide, domperidone
597
Small bilateral groin swellings?
Complete androgen insensitivity syndrome
598
Klienfelters gonadotrophin levels?
High
599
Secondary causes of hypercholesterolaemia not triglycerides?
Nephrotic syndrome Cholestasis Hypothyroidism
600
Fluid retention with pioglitazone increased if taken with?
Insulin
601
9am cortisol between 100-500nmol/l?
inconclusive and requires short synacthen test
602
What is Bartter's syndrome?
defective NKCC2 channel in the ascending loop of Henle
603
What can reduce the absoprtion of levothyroxine?
Iron or calcium within 4 hours
604
Hashimotos thyroiditis is linked to what cancer?
Lymphoma
605
Testosterone low?
Kallman syndrome
606
What is the most common cause of primary hyperaldoesteronsim?
Bilateral idiopathic adrenal hyperplasia
607
HLA antigens are on chromosome?
6
608
Latex in what fruit?
Banana
609
Hypopigmented lesions with reduced sensation?
Leprosy
609
Antibody associated with breast Ca and ocular opsoclonus-myoclonus?
Anti-Ri
610
What is the only licenced CCB in HTN?
Amlodipine
611
Chlamydia treatment in pregnancy?
Erythromycin, azithromycin
612
Bacterial vaginosis is caused by?
Gardnerella vaginalis
613
Mechanism of action of cyclizine?
H1 receptor antagonist
614
Mechanism of action of metoclopramide, domperidone/
D2 receptor antagonist
615
Small intestine overgrowth test?
Hydrogen breath test
616
Treatment for SI overgrowth?
Rifaximin
617
Increased risk of C. diff if taking?
PPI
618
Cholera gram stain?
Gram neg common shaped, single flagellum
619
Complications of coeliac disease?
Hypothyroidism Malabsoprtion Osteoporosis Enteropathy associated T cell lymphoma (NHL)
620
Whipples disease treatment?
2w IV ceftriaxone then 12-24 months Po co-trimoxazole
621
Docusate sodium?
Stool softener
622
Lactulose and macrogol?
Osmotic
623
Senn, bisacodyl, sodium picosulfate?
Stimulant
624
What is Plummer-Vinson syndrome?
Dysphagia with IDA due to upper esophageal web
625
Investigation for achalasia?
Manometry (failure of lower sphincter to relax)
626
Achalasia barium swallow?
Birds beak
627
Why no OGD in pharyngeal pouch?
Risk of perforation
628
Baretts can progress to?
oesophageal adenocarcinoma (colomnar epithelium)
629
Low grade Barrets?
PPI review 6 months
630
High grade Barrets?
Ablation
631
Triple therapy for H. pylori?
PPI Clarithromycin Amoxicillin (metro in pen allergy)
632
H. pylori more increased risk of?
Duodenal ulcers
633
What is Zollinger-Ellison syndrome?
Gastrinoma releasing excess gastrin
634
Investigation for Zollinger-Ellison syndrome?
Secretin stimulation test
635
Investigation for gastroparesis?
solid meal gastric scintigraphy
636
4 Stages of hepatic encephalopathy?
1- Altered mood and behaviour 2- Drowsiness, confusion, personality change 3- Incoherency, asterixis 4- Coma
637
Indications for liver transplant in paracetamol overdose?
pH <7.2 24h post ingestion PT >100 + creat >300 + grade 3/4 encephalopathy
638
Indications for liver transplant not due to paracetamol overdose?
PT >100 Any 3 of: - drug induced liver failure - age <10 or >40 - 1 week from jaundice to encephalopathy - Bili 300+
639
Dose over what for paracetamol overdose?
150mg/kg
640
NAC guidelines?
<1h = charcoal 4 hour level and nomogram 8-24 NAC immediately >24h jaundices/RUQ pain, high ALT, INR >1.3, paracetamol detectable NAC immediately
641
Type 1 autoimmune hepatitis?
Anti-SMA ANA
642
Type 2 autoimmune hepatitis?
Anti liver/ kidney microsomal antibodies type 1
643
Type 3 autoimmune hepatitis?
Anti soluble liver-kidney antigen
644
Anti-HBs positive all others negative?
Previous immunisation
645
Anti-HBc positive, HBsAg negative?
Previous infection, not a carrier
646
Anti-HBc positive, HbsAg positive?
Previous hep B now a carrier
647
What type of virus is Hep A?
RNA piconavirus
648
Transmission of Hep A?
Facecal-oral
649
What type of virus is Hep B?
dsDNA virus
650
Transmission of Hep B?
Bodily fluids Vertical
651
IgM in hepatitis?
Acute
652
IgG in hepatitis?
Chronic
653
What type of virus is Hepatitis C?
RNA virus- flaviviridae
654
Complications of Hep C?
Cirrhosis HCC PCT
655
How is Hep C trasmitted?
Bodily fluids
656
Investigation for Budd-Chiari syndrome?
Doppler USS
657
Thiamine is vitamin?
B1
658
Indications for TIPPS?
- Secondary prophylaxis for oesophageal varices bleeding - Refractory ascites - Portal HTN in Budd-Chiari syndrome
659
Drugs causing cholestasis?
Steroids Co-amoxiclav Flucloxacillin Nitrofurantoin
660
Two disorders of conjugation?
Gilberts Crigler-Narjar
661
Gilbert syndrome seen as?
Intermittent jaundice at times of stress not needing treatment
662
Gilbert syndrome if a deficiency of and mutation?
Gluconyltranferase enzyme UGT1A1
663
Crigler-Naajar seen as?
Pre hepatic jaundice needing liver transplant
664
Crigler-Naajar defeciency?
Diphosphate glucuorsyltransferase
665
Mutation in Wilsons?
ATP7B on Chr 13
666
Diagnosis of wilsons disease?
Genetic analysis of ATP7B gene
667
Bloods in wilsons disease?
Low serum caeruloplasmin Free copper increased Reduced total serum copper
668
Management of wilsons?
Penicillamine (or trientine hydrochloride)
669
Haemachromatosis investigation?
Transferrin saturation High ferritin Low TIBC
670
Mutations in haemachromatosis?
H63D CD82Y
671
Treatment of haemachromatosis?
Venesection T sat <50 Ferritin <50 Second line desferrioxamine
672
Primary biliary cirrhosis is?
Autoimmune scarring and stricture of intrahepatic ducts linked to HCC
673
Primary sclerosing cholangitis is?
Autoimmune scarring and stricture of intra and extra hepatic ducts linked to UC
674
Signs of PSC on biopsy and imaging?
Beaded sign Onion skin histology
675
Complications of PSC?
Cholangiocarcinoma Colorectal cancer
676
Modified Glasgow Score for pancreatitis?
PaO2 Age >55 Neutrophils >15 Calcium <2 Renal function- Urea >16 Enzymes LDH >600 Albumin <32 Sugar >10
677
Pancreatitis is associated with calcium being?
Low
678
Alpha-1 anti trypsin deficiency mutation?
SERPINA1 gene- PIZZ most severe
679
What happens in alpha-1 antityrpsin?
Reduced protection agaisnt neutrophil elastase
680
Liver biopsy of alpha-1 anti trypsin?
Periodic acid schiff positive globules
681
Smoking is protective in?
UC
682
Truelove and Witts criteria of UC?
- Bowel movements a day: 4-6 moderate, 6+ severe - Blood in stools: small mild, severe visible - Pyrexia severe - Pulse >90 severe - Anaemia in severe - Erythrocytes: moderate 30, severe >30
683
Pyoderma granenosum is seen as and associated with?
Ulcer with purple overhanging edge IBD
684
What is Hairy leucoplakia?
benign condition caused by EBV and suggestive of underlying HIV infection.
685
Familial adenomatous polyposis gene?
APC - AD
686
FAP is treated prophylactically with?
Proctocolectomy
687
What is gardeners syndrome?
Variant of FAP with epidermal cysts, supernummery teeth, osteomas and thyroid tumours
688
Genetics of Lynch syndrome (HNPCC)?
AD mismatch repair genes mutation
689
Mode of action of SU gliclazide?
binds to ATP dependant K channels on beta cells
690
In pregnancy what thyroid associated protein increases?
thyroid binding globulin
691
Hormones in Klienfelters syndrome?
high LH and low testosterone
692
Elderly person with Diarrhoea + hypokalaemia
villous adenoma
693
Gastrin acts on?
Gastric parietal cells
694
PBC increased risk of HCC?
20 fold
695
What electrolyte in refeeding syndrome causes muscular weakness?
HypoPhosphataemia
696
Most gastrinomas are found in the?
first part of the duodenum
697
Bile acid malabsorption following IBD resection?
cholestyramine
698
Hypoglycaemia and jaundice in pregnancy?
Acute fatty liver of pregnancy
699
Lynch syndrome increases the risk of what 2 cancers?
Colorectal Endometrial
700
Primary biliary cholangitis - the M rule?
IgM anti-Mitochondrial antibodies, M2 subtype Middle aged females
701
What affects the Urea breath test?
Abx 4 weeks PPIs 2 weeks
702
Goblet cell depletion?
UC
703
cholangitis investigation?
USS
704
Hepatorenal syndrome type 1?
Rapid onset <2 weeks can be triggered by UGIB
705
Hepatorenal syndrome type 2?
Gradual onset associated with refractory ascites
706
CCK (bile acids) are secreted from?
I cells in upper small intestine
707
Clindamycin SE?
Diarrhoea, high risk for C. diff
708
Liver cirrhosis biopsy shows?
excess collagen and extracellular matrix deposition leading to formation of regenerative nodules
709
Liver biopsy of alcoholic steatohepatitis?
Macrovesicular fatty changes with giant mitochondria, spotty necrosis and fibrosis
710
What is a VIPoma?
neuroendocrine tumour from the non-beta islet cells of the pancreas secreting vasoactive intestinal peptide
711
Drugs causing dyspepsia?
Steroids NSAIDs Bisphosphonates - relax LOS calcium channel blockers nitrates theophyllines
712
What can cause decompensation in cirrhosis?
Constipation Infection Electrolyte imbalance dehydration Increased alcohol UGIB
713
Vaccines in coeliacs disease?
Pneumococcal every 5 years due to hyposplenism Yearly influenza
714
Non responders to Hep B vaccination should be tested for?
Coeliacs
715
Immunological subtypes and alcoholic liver disease?
IgA
716
Immunological subtypes and PBC?
IgM
717
Immunological subtypes and autoimmune hepatitis?
IgG
718
What is Dubin-Johnson syndrome?
Benign AR with defective conjugated hepatic bilirubin excretion
719
Defect in Dubin-Johnson syndrome?
cMOAT protein
720
Drugs that cause pancreatitis?
azathioprine mesalazine didanosine bendroflumethiazide furosemide pentamidine steroids sodium valproate
721
What calcium can cause pancreatitis?
hypercalcaemia
722
What can Hyperchylomicronaemia cause?
Pancreatitis
723
Causes of pancreatitis?
Gallstones Ethanol Trauma Steroids Mumps (other viruses include Coxsackie B) Autoimmune (e.g. polyarteritis nodosa), Ascaris infection Scorpion venom Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia ERCP Drugs
724
SAAG >11?
Portal HTN - Cirrhosis - HF - Budd-Chiari
725
SAAG <11?
Cancer TB Pancreatitis
726
Pruritic rash on the buttocks or soles?
Strongyloides stercoralis
727
Mode of action of oseltamivir?
Neuramindase inhibitor
728
Mode of action of acyclovir?
Inhibits DNA polymerase
729
Mode of action of remdesivir?
Inhbits RNA polymerase
730
Grey coating of tonsils?
Diphtheria
731
Cause of Diphtheria?
Corynebacterium diphtheriae
732
Bilateral perihilar shadowing in HIV?
Pneumocystis jirovecii
733
Management of Pneumocystis jirovecii with exertional sats drop?
Oral co-trimoxazole +/- steroids (if sats drop)
734
Fish tank granuloma?
Mycobacterium marinum
735
Parovirus B19 in pregnancy?
Risk of fetal hydrops- fetal transfusion
736
LTRI in cardiomyopathies and alcoholics, with upper lobar involvement?
Klebsiella
737
Tuberculoid leprosy seen by?
limited number of skin lesions, hypaesthesia and hair loss
738
Lepromatous leprosy seen by?
Widespread involvement skin nodules Leonine facies (thickened forehead, loss of eyebrows and eyelashes).
739
Treatment of cutaneous larva migrans?
Thiabendazole
740
Treatment of leprosy?
Dapsone
741
Signs of CNS cryptococcal infection
HIV Neuro symptoms Lymphocytes High opening pressure High protein Normal glucose
742
Investigation for CNS cryptococcal infection?
India ink staining
743
Clostridium is a?
Gram-positive rod
744
Treatment of latent syphilis?
benzathine penicillin IM
745
Black painless eschar seen in?
Anthrax
746
Treatment of anthrax?
ciprofloxacin
747
African sleeping sickness is?
trypanosomiasis (African sleeping sickness)
748
Lassa virus from?
Rats
749
Brucella diagnosis from unpastrurised milks?
Serology
750
Toxoplasmosis and immunocompetent?
Supportive treatment
751
Toxoplasmosis and immunocompromised?
Pyrimethamine + sulphadiazone
752
Chronic Hep C test?
anti-HCV antibody test
753
In syphilis regardless of treatment what stays positiev?
Treponema pallidum haemagglutination test (TPHA)
754
Yellow fever presentation?
Jaundice and UGIB
755
Tetanus is the inhibition of?
GABA
756
Kaposi's sarcoma is caused by what virus?
HHV-8 (human herpes virus 8)
757
Action of Rifampicin
inhibits RNA synthesis
758
peripheral blood smear showing red blood cell agglutination which pneumonia causing bacteria, and erythema multiforme (target lesions)?
Mycoplasma pneumoniae
759
Mechanism of action of tetracyclines?
inhibit the 30S subunit of ribosomes
760
American trypanosomiasis?
Chagas disease/ cruzi
761
How is chagas disease presented?
Periorbital oedema Dilated cardiomyopathy
762
Treatment of chagas disease?
Benzdazole
763
Egg proteins seen in which vaccine?
Yellow fever
764
Triad of Disseminated gonococcal infection?
Dermatitis Migratory polyarthritis Tenosynovitis
765
False negatives on tuberculin test occur due to?
immunodeficiency e.g., HIV, lymphoma, sarcoidosis
766
Treat campylobacter with?
Clarithromycin
767
Shigella abx?
Ciprofloxacin
768
In HIV treatment Integrase inhibitors ('gravirs') have what mode of action?
blocks the enzyme that inserts the viral genome into the DNA of the host cell
769
EBV is associated with which 3 malignancies?
Burkitt's lymphoma Hodgkin's lymphoma nasopharyngeal carcinoma
770
Rickettsia ricketsii is?
Rocky Mountain Spotted Fever
771
Surgical third nerve palsy?
Pupil involved- posterior communicating artery aneurysm
772
How is conus medularis syndrome seen?
cauda equina with hyperreflexia
773
Charcot marie tooth syndrome seen as?
Sensory and motor neuropathy Pes cavus Muscle wasting Thickening of nerves
774
Charcot marie tooth inheritance?
AD PMP22
775
Motor region in the?
Frontal lobe
776
Sensory area in the?
Parietal
777
Empty delta sign?
Intracranial venous thrombosis
778
What is the mode of action of mannitol?
Osmotic diuretic on PCT and loop of henle
779
How is cerebellar syndrome seen?
DANISH Dysdiadochokinesia Ataxia Nystagmus (downbeat) Intention tremor Slurred speech Hypotonia
780
How is Freidrichs ataxia seen?
Teens with upper and lower MN lesions, high arched palate, cerebellar signs
781
Hereditary spastic paraparesis seen as?
Lower limb spasticity and hyperreflexia
782
MND is due to?
misfolding of the TDP-43 protein
783
Duchennes and Becks dystrophy?
X linked recessive
784
Myotonic Dystrophy inheritance?
AD
785
Presentation of myotonic dystrophy?
frontal balding early cataracts percussion myotonia (difficult to release handshake) dysarthria first degree heart block
786
Antibodies associated with myasthenia gravis?
ACh-R antibodies, MuSK antibodies, LRP4 antibodies
787
Drugs exacerbating myasthenia gravis?
BB, lithium, penicillamine, gentamicin, quinolones, phenytoin
788
Management of myasthenia gravis?
pyridostigmine or neostigmine
789
Management of myasthenia crisis?
IV immunoglobulins and plasma exchange. Intubation and ventilation if FVC 15ml/kg or less
790
Mechanism of action of baclofen
GABA analogue and selective agonists at GABA-b receptors, lipophilic
791
HSV-1 encephalitits?
temporal lobes
792
Anti-NMDA receptor encephalitis associated with?
Ovarian teratoma
793
Triad of wernickes encephalopathy?
ataxia, confusion and ocular abnormalities (gaze evoked upbeat nystagmus)
794
Acanthamoeba Meningitis is associated with?
Contact lens infection
795
In CSF high protein and low glucose both in?
Bacterial and TB
796
Ischaemic penumbra is the?
Area of ischaemia without necrosis in stroke
797
Patent foramen ovale test (Stroke and DVT)?
Bubble ECHO
798
Absent seizures?
Ethosuximide (unless pregnant/ breastfeeding)
799
Driving and epilepsy?
1 seizure 6 months 1+ 1 year Professional 1 5 years Professional 1+ 10 years
800
Miller fisher variant antibodies?
Anti-GQ1B antibodies
801
When to intubate in GBS?
FVC <20ml/kg
802
LP in GBS?
Isolated protein rise Albumincytological dissociation
803
Foot drop is caused by?
Common perineal nerve injury
804
What is meralgia parethetica?
Compression of lateral cutaneous nerve seen with pains on outer aspect of thigh
805
Weakness following exercise/ fasting/ infection with myoglobinuria?
Carnitine plamitoyl transferase deficiency
806
Diagnosis of Carnitine plamitoyl transferase deficiency?
Muscle biopsy
807
Unexplained syncope and dribing?
No driving 6 months
808
Prophylaxis for cluster headaches?
Verapamil
809
Antibodies and mechanism of action in lambert eaton myasthenic syndrome?
Anti VGCC against calcium channels
810
Lambert eaton is associated with which cancer?
SCLC
811
Treatment of lambert eaton syndrome?
Amifampridine
812
What is Paraneoplastic Encephalomyelitis?
Autoimmune encephalitis linked to SCLC with labile emotions and memory impairment
813
What is MELAS?
Mitochondrial encephalopathy, lactic acidosis, stroke like episodes
814
Muscle biopsy of MELAS?
Ragged red fibres
815
What is Devics disease also called?
Neuromyelitis optica (NMO)
816
How is NMO seen?
Peripheral and central demyelination - optic neuritis - Transverse myelitits (weakness, paralysis, sensory disturbance) - Aquaporin 4 antibodies
817
Causes of drug induced parkinsonism?
Haloperidol Risperidone Metoclopramide
818
Cause of parkinsons disease?
Lewy body formation- intracellular inclusions of misfolded alpha synuclein
819
Difference between lewy body dementia and parkinsons dementia?
Lewy body dementia- memory loss before or at the same time Parkinsons disease dementia- years after motor symptoms
820
Cause of progressive supranuclear palsy?
Tau deposition, often atremulous
821
Cause of multi system atrophy?
Alpha synuclein deposition
822
How is corticobasal degeneration seen?
Apraxia and aphasia Alein hand syndrome
823
Cause of corticobasal degeneration?
Intracellular tangles of misfolded tau proteins
824
Symptomatic control of reversible cerebral vasoconstriction syndrome?
Nimodipine
825
Medications leading to serotonin syndrome?
SSRIs, MDMA, ecstasy, MAOI, amphetamines, fentanyl, sumatriptan, ondansetron
826
Acute labyrinthitis?
Vertigo and hearing loss/ tinnitus
827
Vestibular neuritis?
Vertigo but hearing intact
828
Nutrition support in MND?
PEG
829
Conduction aphasia?
Cant repeat
830
Diplopia with parkinsonism?
Progressive supranuclear palsy
831
Ataxic telangiectasia: cerebellar ataxia and telangiectasia, onset is in childhood gene?
ATM gene
832
Query SAH but no signs on CT within 6 hours of onset of symptoms?
Consider other diagnosis
833
Bitemporal hemianopia- optic chiasm compression upper or lower?
Upper quadrant defect = inferior chiasmal compression, commonly a pituitary tumour Lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma
834
Haemochromatosis doesnt really affect the?
CNS
835
How is Juvenile myoclonic epilepsy seen?
seizures in the morning/following sleep deprivation
836
Ondansetron works of the chemoreceptor trigger zone in the?
Medulla oblongata
837
Sensory neuropathies include?
diabetes uraemia leprosy alcoholism vitamin B12 deficiency amyloidosis
838
Causes of HTN in NF-1?
phaechromocytoma (check catelcholamines) renal vascular stenosis secondary to fibromuscular dysplasia
839
Cluster headache acute management?
100% oxygen, SC sumatriptan
840
Side effect of Natalizumab?
reactivation of the JC virus causing progressive multifocal leukoencephalopathy (PML)
841
Tuberous sclerosis is seen with?
depigmented 'ash-leaf' spots Shagreen patches angiofibromas subungual fibromata cafe-au-lait spots
842
Risk of what in nephrotic syndrome?
VTE due to loss of antithrombin III
843
How is renal vein thrombosis seen?
Commonly with nephrotic syndrome Loin pain Haematuria
844
Treatment of renal vein thrombosis?
warfarin
845
What is beurgers disease?
IgA nephropathy
846
What is IgA nephropathy?
Nephritic syndrome 1-2 days after URTI
847
What is post strep glomerulonephritis?
1-3 weeks post strep nephritic syndrome
848
What kind of strep causes post strep glomerulonephritis?
Group A B haemolytic strep
849
Biopsy of post strep glomerulonephritis?
Subepithelial bumps
850
Tests high in post strep glomerulonephritis?
DNase ASOT
851
What is good pastures syndrome?
Anti GBM with pulmonary haemorrhage and AKI
852
Biopsy of good pastures syndrome?
IgG standing on basement membranes Necrotising crescents
853
How is alport syndrome seen?
X linked dominant condition with: Hearing loss Optic issues Haematuria
854
What is the defect and biopsy findings of Alport syndrome?
Defect in collagen IV Splitting of lamina densa and basket weave
855
cup and spill/ egg in a cup?
Renal papillary necrosis
856
What is acute interstitial nephritis?
Acute hypersensitivity reaction with rash, eosinophilia and fever
857
Common drug causes of AIN?
Allopurinol Abx NSAIDs Diuretics PPIs
858
Causes of membranoproliferative glomerulonephritis?
Hep C Cryoglobulinaemia Monoclonal gamminopathy
859
Biopsy finding of membranoproliferative glomerulonephritis?
Double contour basement membrane
860
Wergner's (GPA) has?
cANCA
861
cANCA is?
PR3
862
Wergners is seen with?
Sinusitis, epistaxis, pulmonary haemorrhage
863
Churg strauss (EGPA) has?
pANCA
864
pANCA is?
MPO from monocytes
865
churg strauss is seen as?
Allergic asthma, nasal polyps, esoinophilia
866
Renal anaemia only expected with eGFR?
45
867
Hb target in CKD?
100-120
868
EPO only when?
Ferritin >100 (200 haemodialysis) Tsat >20
869
Kimmelsteil-wilson nodules are seen in?
Diabetic nephropathy
870
Complication of long term dialysis leadign to CTS?
Beta 2 microglobulin amyloidosis
871
CMV activation post renal transplant time frame?
6 weeks
872
Treatment of CMV reactivation?
Gangcilovir
873
Acute rejection of kidney transplant?
Within 6 months T cell mediated
874
PKD1 chromosome?
16
875
PKD2 chromosome?
4
876
Treatment of PKD?
Tolvaptan
877
Apple green birefriegence on congo red stain?
Amyloidosis
878
Fusidic acid, clarithromycin, statins, colchicine increases risk of?
Rhabdomyolysis
879
Struvite stones assoicated with?
Staghorn calculus and proteus infection
880
Epithelial casts in urine?
ATN
881
fatty casts in urine?
Nephrotic syndrome
882
Bladder cancer associated with schistosomiasis and LTC >10 years?
SCC
883
RTA type 1?
Distal Unable to excrete H+ DCT/CD
884
RTA type 2?
Proximal Unable to reabsorb HCO3- in PCT
885
RTA type 4?
HyperKa Low aldosterone
886
What can cause a false negative PSA (reducing it)?
Finasteride
887
What are intensely painful, purpuric patches with an area of black necrotic tissue seen on the legs in ESRD with poor attendance?
Calciphylaxis lesion
888
How do you differentiate from prerenal uraemia and ATN?
Urinary Na High ATN Low Prerenal uraemia
889
If starting goserelin co-prescribe what for the first 3w?
cyproterone acetate - risk of tumour flare
890
What is cyproterone acetate?
Anti-androgen treatment start at same time as goserelin
891
What drug in post renal transplant gives you a tremor?
Tacrolimus
892
Site of action of spironolactone?
cortical collecting ducts
893
Lithium causes which type of DI?
Nephrogenic
894
How do you calculate anion gap?
(Na+ + K+) - (Cl- + HCO-3)
895
What is a normal anion gap?
10-18
896
How long for arteriovenous fistula to develop so it can be used?
6-8 weeks
897
RAS investigation?
MR angiogram
898
Which renal disorder is associated with malignancy?
Membranous glomerulonephritis
899
Atypical HUS is?
HUS without diarrhoea/ abdo pain/ E. coli
900
Type 2 membranoproliferative glomerulonephritis is seen as?
Lipodystrophy with low C3
901
Biopsy of FSGS?
Podocyte proliferation and collapse of basement membrane
902
Treatment of epididymal orchitis?
IM ceftriaxone stat + oral doxycycline for 2 weeks
903
High phosphate in CKD due to?
Reduced excretion
904
Heroin use is linked to which renal disease?
focal segmental glomerulosclerosis
905
Granulomatosis with Polyangiitis (GPA) linked to which renal disease?
Rapidly progressive glomerulonephritis
906
Mechanism of action of Tolvaptan?
vasopressin receptor 2 antagonist
907
Mechanism of action of Bicalutamide for prostate Ca?
androgen receptor blocker
908
SLE linked to which renal disorder?
diffuse proliferative glomerulonephritis
909
Restrictive spirometry?
>0.7 In MND, myasthenia, ILD
910
Obstructive spirometry?
<0.7 FEV1 reduced Asthma, COPD
911
If ? asthma with eosinophilia worsened by steroids consider?
Strongyloides
912
Moderate acute asthma?
50-75%
913
Severe acute asthma?
33-50% HR >110 RR >25 Cant complete sentences
914
Life threatening acute asthma?
<33% Sats <92% Silent chest Tiring PaO2 <8
915
Near fatal acute asthma?
Raised paCO2 Mechanical ventilation with increasing inflation pressures
916
Ipratropium bromide mechanism of action?
SAMA Antagonises acetlycholine
917
Indications for lung reduction therapy in COPD?
* Upper lobe predominant emphysema * FEV1 >20% predicted * PaCO2 <7.3 * TLCO >20% predicted
918
Criteria for LTOT?
PaO2 <7.3 on 2 occassions 3 weeks apart PaO2 <8 + cor pulmonale, polycythaemia, pulmonary HTN
919
How long should you use LTOT?
Atleast 15 hours a day
920
Investigation for bronchiectasis?
High resolution CT showing: Tram lines Ring shadows Signet ring
921
When give prophylaxis in broncheictasis?
>3 exacerbations a year
922
Pseudomonas aeruginosa treatment?
Po cipro IV tazocin Nebulised colomycin
923
What is allergic bronchopulmonary aspergillosis?
High IgE against aspergillus fumigatus. Treat with steroids and antifungals
924
What is bronchiolitis obliterans?
Obstructive destruction by granulation tissue seen in RA or post lung transplant
925
How do you treat bronchiolitis obliterans?
immunosuppression
926
High resolution CT findings of ILD?
Honey combing Ground glass
927
If broncholavage in ILD >50% lymphocytes?
Add immunosuppression
928
Upper interstitial lung disease causes?
HART Hypersensitivity pneumonitis Ankylosing spondylitis Radiotherapy TB
929
Causes of lower lung fibrosis in ILD?
RAIDS RA Asbestosis Idiopathic Drugs Sarcoidosis
930
What drugs cause ILD lower fibrosis?
Methotrexate Bleomycin Amiodarone Nitrofurantoin
931
Treatment of idiopathic pulmonary fibrosis (lower zone)?
Pirfenidone Nintedanib
932
Mechanism of action of Pirfenidone for idiopathic ILD?
Decreases fibroblast
933
Mechanism of action of nintedanib for idiopathic ILD?
TKI
934
Cystic fibrosis mutation and chromosome?
Cr 7 CFTR
935
CF most common variant?
Delta- F508
936
Contraindications to lung transplant?
- Other organ failure - Untreated CAD - Malignancy within last 5 years - TB infection - Poor support or follow up compliance - Relative contraindication: Burkholderia cepacian or mycobacterium abscessus
937
Signs of massive PE needing thrombolysis?
Hypotension <90 for >15 mins Cyanosis R heart train (raised JVP, loud P2 and parasternal heave)
938
Redcurrant sputum?
Klebsiella
939
Mycoplasma pneumonia associated with?
Cold AIHA Target lesions or erythema multiforme
940
Exudative pleural effussion?
Protein >35
941
What is a chylothorax?
Lymph fluid with high cholesterol after trauma
942
What is meig syndrome?
Ovarian tumour Ascites Pleural effussion
943
Catamenial pneumonthorax?
Secondary to endometrosis
944
Pneumothorax not responding after 48h?
Surgery
945
How long til you can fly post radiological resolution of pneumothorax?
7 days
946
What biologic can reactive TB?
Inflixamab
947
Rifampicin SE?
Red coloured bodily fluids
948
OHS seen as?
Chronic respiratory acidosis
949
CD4 count for PCP?
<200
950
Signs of PCP?
Peri hilar Crushed ping pong ball sign
951
Treatment of PCP?
IV co-trimoxazole + steroids
952
PiMZ in alpha-1-anti trypsin deficiency?
carrier and unlikely to develop emphysema if a non-smoker
953
Normal genotype not alpha-1 anti trypsin?
PIMM
954
Alpha 1 anti tyrpsin deficiency meaning of genotype?
S- slow enzymes 50% normal Z- very slow enzymes 10% normal
955
First line investigation for asthma?
measure the eosinophil count OR fractional nitric oxide
956
Look at upper airway compression best with?
Flow volume loop
957
Good prognostic factors in sarcoidosis?
HLA B8 Lofgren's syndrome (bilateral hilar lymphadenopathy, erythema nodosum, polyarthritis and fever)
958
Stages of COPD?
1- mild >80 2- moderate >50 3- severe >30 4- very severe <30
959
Most common cause of IECOPD?
Haemophilus influenzae
960
Pleural plaques and FU?
Dont need
961
how many % of patients diagnosed with lung ca have a normal CXR?
10%
962
varenicline used in smoking cessation linked to?
suicidal behaviour
963
Farmers lung is?
Saccharopolyspora rectivirgula
964
Recommended settings for NIV for COPD?
EPAP: 5 cm H2O IPAP: 10 cm H20 whilst BTS suggest 12-15 cm H2O back up rate: 15 breaths/min
965
Most people with sarcoidosis get better with?
without treatment
966
CXR sarcoidosis stages?
1 = BHL 2 = BHL + infiltrates 3 = infiltrates 4 = fibrosis
967
High risk characterisitics of pneumothorax needing chest drain?
Haemodynamic compromise Significant hypoxia Bilateral pneumothorax Underlying lung disease ≥ 50 years of age with significant smoking history Haemothorax
968
HLA of RA?
HLA DR4 HLA DR1
969
Most specific antibody for RA?
Anti-CCP
970
Bets prognosis in RA?
RF negative
971
Poor prognosis in RA?
Male Early development Erosions RF Anti CCP
972
What is felty syndrome?
RA Neutropenia Splenomegaly
973
What is caplan syndrome?
RA nodules Coal workers lung
974
DAs-28 in remission?
<2.6
975
Management stages of RA?
1. methotrexate 2. + sulfasalazine/ leflunomide 3. DAS 28 >5.2 methotrexate + anti TNF 4. Methotrexate + rituximab
976
Examples of anti TNF?
Adalimumab Infliximab
977
Starting rituximab check?
Hep B
978
Starting methotrexate screen?
CXR HBV, HCV
979
Give what with methotrexate?
Folic acid OW
980
What not to take or do on methotrexate?
X pregnancy 3 months X progaunil, trimethoprim
981
SE of sulfasalazine?
Decreases sperm count Flare of G6PD Agranulocytosis
982
Pencil in the cup?
Psoriatic arthritis
983
What DMARD not to give in psoriatic arthritis?
Hydroxychloroquine, exacerbates skin
984
What is keratoderma blenorrhagica?
Dark maculopapular rash on palms and soles seen in reactive arthritis
985
Most common cause of septic arthritis?
Staph aureus
986
Most common cause of septic arthritis following replacement?
Staph epidermis
987
Stills disease?
High temp Salmon pink rash High ferritin >1500 Leucocytosis and neutrophilia
988
Treatment of still disease?
NSAID + aspirin
989
Gout can be caused by which renal issue?
Lesch nyhan syndrome
990
GCA USS?
Halo sign
991
Biopsy of GCA?
Multinucleated giant cells
992
Management of GCS?
Aspirin + high dose pred Any visual symptoms pulsed IV methylprednisolone
993
Polymyositis antibody?
Anti-Jo-1
994
Muscle biopsy of polymyositis?
Endomysial infiltrates
995
Muscle biopsy of dermatomyositis?
Perivascular infiltrates
996
Antiphospholipid diagnosis?
2 tests 12 weeks apart
997
Management of antiphospholipid syndrome?
Aspirin + warfarin
998
SLE hypersentivity reaction?
Type 3
999
What is low in SLE?
C3/4
1000
Most common antibody in SLE?
ANA
1001
Most specific antibody?
Anti smith (SnRNP) Anti dsDNA
1002
Drug induced lupus antibody?
Anti histone
1003
Subacut cutaneous lupus antibody?
ANA Anti-SS-A Anti-SS-B
1004
Treatment of SLE?
NSAID + hydroxycloroquine
1005
Sjrogens hypersensitivity reaction?
Type IV
1006
Increased risk of what cancer with sjorgens?
Lymphoma
1007
CREST syndrome AKA
Limited cutaneous sclerosis
1008
Antibody of limited cutaneous sclerosis (CREST)?
Anti centromere
1009
Risk of what with CREST and anti centromere?
pulmonary HTN
1010
Diffuse sclerosis antibody?
Anti SCl 70
1011
Risk with anti Scl-70?
ILD
1012
HLA B27 associated with?
A REAP Ankylosing spondylitis Reactive arthritis Enteropathic arthritis Anterior uveitis Psoriatic arthritis
1013
Osteoporosis T score?
<2.5
1014
What is subclavian steel syndrome?
Syncope on upper body exercise due to thoracic outlet obstruction
1015
What is key to RA pathophysiology?
TNF
1016
What does the Z score do?
diagnosing secondary osteoporosis
1017
What is McArdle's disease?
Myophosphorylase deficiency seen as dark urine on exercise with myoglobin and CK
1018
Pagets associated with increased?
hydroxyproline
1019
Golimumab is a
TNF inhibitor
1020
Causes of drug induced lupus?
procainamide hydralazine isoniazid minocycline phenytoin
1021
Anti bodies of anti phsopholipid syndrome?
lupus anticoagulant beta-2 glycoprotein antibody cardiolipin antibody
1022
Rheumatoid factor is an Ig what?
IgM antibody against IgG
1023
Pilocarpine for?
Dry mouth
1024
How is lateral epicondylitis seen?
worse on resisted wrist extension/suppination whilst elbow extended
1025
What is the most common cardiac defect in marfans?
dilation of the aortic sinuses
1026
Mechanism of action of Mycophenolate mofetil?
inhibits inosine-5'-monophosphate dehydrogenase
1027
Mechanism of action of methotrexate?
Reversible inhibitor of dihydrofolate reductase
1028
If 75 and over with a history of fragility fractures what is the next stage in management?
Bisphosphonate without requiring a DEXA scan
1029
Most common organism in osteomyelitits?
Staph aureus
1030
Gout is most commonly caused by?
Decreased uric acid secretion
1031
Positive femoral stretch test?
L4
1032
What secrets most of TNF?
Macrophages
1033
SE of leflunoamide?
HTN
1034
etanercept mode of action?
TNF-A
1035
TNF-a can cause reactivation of?
TB
1036
CREST is associated with malabsorption because?
SBBO
1037
GCA vision loss most likely due to?
Anterior ischemic optic neuropathy (AION).
1038
Azathioprine in pregnancy?
Safe
1039
Osteoporosis in men check?
Testosterone
1040
Mechanism of action of dabigatran and bivalrudin?
Direct thrombin inhibitors
1041
Direct thrombin inhibitors have an increased?
APTT Intrinsic
1042
How does LMWH and fondaparinux work?
Activated anti thrombin III which inhibits Xa
1043
How does apixaban and rivaroxaban work?
Direct Xa inhibitors
1044
How does unfractionated heparin work?
Creates a complex inhibiting factors 9-12a
1045
Reversal of unfractionated heparin?
Protamine sulphate
1046
Reversal of apixaban?
Andexanet alfa
1047
How does warfarin work?
Inhibits Vit K dependant factors: 2, 7, 9, 10 Protein S, C
1048
Warfarin increases the?
PT extrinsic
1049
High INR no bleeding >5 but <8?
Hold 1-2 doses Review maintanence dose
1050
High INR no bleeding >8?
Stop anticoag Oral or IV vitamin K Repeat 24 hours
1051
Minor bleeding with high INR?
Stop anti coag IV vit K Repeat 24 h
1052
Major bleeding with high INR?
Stop anticoag IV vitamin K Prothrombin complex
1053
Target cells?
Post splenectomy IDA
1054
Heinz bodies?
G6PD Thalassaemia
1055
Howell-Jolley bodies?
Post splenectomy
1056
Schistocytes?
Haemolytic anaemia HUS DIC TTP Metallic heart valves
1057
Sideroblasts?
Myelodysplastic syndrome
1058
Causes of microcytic anaemia?
TAILS Thalassaemia A + B Iron deficiency Lead poisoning Sideroblastic
1059
Blood findings in haemolytic anaemia?
High bilirubin High LDH High urobilinogen Low haptoglobin
1060
Inheritance of spherocytosis?
AD
1061
Causes of hereditary spherocytosis?
Low spectrin, ankyrin, band 3
1062
Diagnosis of hereditary spherocytosis?
EMA binding
1063
Crisis in hereditary spherocytosis caused by?
Parvovirus B19
1064
Treatment of spherocytosis?
Folate Splenectomy
1065
Inheritance of G6PD?
X linked recessive
1066
When can you do a G6PD assay for diagnosis?
6 weeks after crisis
1067
Ig of warm autoimmune haemolytic anaemia?
IgG
1068
Causes of WAHA?
Lymphocytic leukaemia Lymphoma Macrophages mark for destruction in spleen
1069
Investigation of WAHA?
Flow cytometry DAT +ve
1070
Treatment of WAHA?
Prednisolone Azathioprine
1071
Ig of cold haemolytic anaemia?
IgM
1072
Cold AHA action?
Complement direct haemolysis
1073
A thalassamia types?
2 defects = carrier 3 defects = hb H anaemia 4 defects = hydrops fetalis
1074
Thalssaemia inheritance?
AR
1075
B thalassaemia types?
Minor Major - severe 3-9 months
1076
Diagnosis of B thalassaemia?
HbA2 high
1077
Sickle cell diagnosis?
haemoglobin electrophoresis + genetic testing
1078
management of sickle cell disease to stimulate HbF?
Hydroxycarbamide
1079
Bloods in DIC?
High d-dimer Schistocytes Thrombocytopenia High PT Decreased fibrinogen
1080
DIC linked to which leukaemia?
acute promyelocytic leukaemia
1081
Platelets are produced by?
megakaryocytes
1082
Plts <10?
Spontaneous intracerebral bleed
1083
ITP is?
Immune destruction of plts due to glycoprotein Ib, IIb, IIa complexes
1084
Management of ITP with plts <30 no bleeding?
Steroids
1085
Life threatening bleeding in ITP?
IV steroids IVIG Plts
1086
TTP is caused by?
Low ADAMS13 activity cleaving VWF
1087
management of TTP?
Plasma exchange
1088
Haemophilia and VWD has high?
APTT intrinsic
1089
Haemophilia inheritance?
X linked recessive
1090
Haemophilia seen with?
Haemoarthrosis
1091
Haemophilia A?
Factor 8 low
1092
Haemophilia B?
Factor 9 low
1093
Inheritance of VWF?
AD most common
1094
VWD seen as?
Menorrhagia
1095
Management of polycythaemia rubra vera?
Aspirin and venesection
1096
ALL
Kids
1097
CLL
Smear and smudge cells Ritcher transformation to high grade lymphoma Warm haemolytic anaemia
1098
AML
Auer rods 15:17 PML-RARA Good prognosis DIC Retinoic acid
1099
CML
Philadelphia chromosome 9:22 34:11 BCR-ABL Imatinib
1100
BRAF
Hairy
1101
H. pylori and cancer?
MALT lymphoma
1102
EBV and cancer?
Burkitts lyphoma
1103
Hep C and cancer?
Diffuse large B cell lymphoma
1104
Human T cell virus 1 and cancer?
T cell lymphoma
1105
Poor prognosis in lyphoma?
High LDH
1106
Prognosis for myeloma?
serum B2 microglobulin Albumin
1107
poikilocytes in?
Myelofibrosis
1108
Delivery and plts?
Epidural plts >80 NVD plts >50, avoid instrumental delivery
1109
Anaphylaxis in blood transfusion?
IGA deficiency
1110
Delayed haemolytic reaction to blood transfusion?
5 days after
1111
What happens in factor V ledien?
activated factor V is inactivated 10 times more slowly by activated protein C than normal AKA resistance to protein C
1112
What is given to prevent haemorrhagic cystitis with cyclophosphamide?
Mesna
1113
Most likely SE with cisplatin (platinum based chemo)?
Ototoxicity
1114
Pregnancy can cause which haemolytic anaemia?
TTP
1115
Treatment of methaemoglobinaemia?
Methylene blue
1116
Pancytopenia causes?
Trimethoprim Chloramphenicol Penicillamine Carbimazole Carbemazepine
1117
TTP is seen as a pentad of?
thrombocytopenia microvascular haemolysis fluctuating neurological signs renal impairment fever.
1118
Differentiating CML from leukaemoid reactions use?
leukocyte alkaline phosphatase score LOW CML High leukaemoid reaction
1119
Follicular lymphoma translocation
t(14;18) translocation and increased BCL-2
1120
How is common variable immunodeficiency seen?
Low IgG, IgM and IgA High lymphocytes B cell deficiency
1121
SCID and lymphocytes?
Low
1122
basophilic stippling seen in?
Lead poisoning
1123
Most common type of Hodgkin's lymphoma?
Nodular sclerosing
1124
Doxorubicin what serious SE?
Dilated cardiomyopathy
1125
Vincristine mode of action and SE?
Inhibits formation of microtubles Peripheral neuropathy
1126
Burkitts lymphoma translocation?
c-myc gene translocation
1127
CKD causes increased coagulopathy due to?
antithrombin III deficiency
1128
Why is the hypercalcaemia in myeloma?
Increased osteoclast activation
1129
Tumour marker of peritoneal ca?
Ca 125
1130
Causes of intravascular haemolysis?
mismatched blood transfusion G6PD deficiency red cell fragmentation: heart valves, TTP, DIC, HUS paroxysmal nocturnal haemoglobinuria cold autoimmune haemolytic anaemia
1131
Leucocyte alkaline phosphatase is raised in?
myelofibrosis leukaemoid reactions polycythaemia rubra vera Steroids pregnancy, oral contraceptive pill
1132
Carcinogen linked to HCC?
Aflatoxin
1133
Aniline dyes are a carcinogen for?
TCC
1134
Nitrosamines are a carcinogen for?
Oesophageal, gastric ca
1135
Most common cause of neutropenic sepsis?
Staphylococcus epidermidis
1136
Staphylococcus epidermidis organism?
Coagulase-negative, Gram-positive bacteria
1137
Bombesin is a tumour marker for?
SCLC
1138
Non hodgkins lymphoma chemo treatment?
R-CHOP
1139
Chemo used in CLL?
FCR
1140
Waldenstrom's macroglobulinaemia seen as?
IgM monoclonal paraprotein
1141
Polycythaemia rubra vera and ESR?
ESR low
1142
Test for paroxysmal nocturnal haemoglobinuria?
Flow cytometry for CD59 and CD55
1143
Capgras delusion?
Clones
1144
Lithium >4?
Dialysis
1145
Which antipsychotic is associated with high prolactin?
Risperidone
1146
Clozapine SE?
Agranulocytosis
1147
In IHD and depression give?
Sertraline
1148
Section 2 in?
ED
1149
Section 4 in?
Emergency with 1 person
1150
Section 135?
Enter property
1151
Section 136?
Public place
1152
Which antidepressants can cause urinary retention, dry mouth, blurred vision?
TCA Amitriptyline imipramine
1153
Raised in anorexia?
G's and C's raised: growth hormone glucose salivary glands cortisol cholesterol carotinaemia
1154
How long to stop SSRIs over?
4 weeks
1155
Narcissistic personality disorder?
Self important Lack of empathy Takes advantage
1156
Schizoid personality disorder?
Lack of interest in everything
1157
Schizotypal personality disorder?
Odd beliefs
1158
Antidepressant to avoid in overdose risk?
Dosulepin
1159
BZ mode of action?
Enhances GABA
1160
Lithium levels should be checked every?
3 months
1161
Safest TCA in overdose?
Lofepramine
1162
Increasing pain management in palliative by?
30-50%
1163
Metastatic bone pain management?
Opioids Bisphosphonates
1164
Oral to SC/IV/IM morphine?
/2
1165
Oral morphine to codeine/tramadol?
/10
1166
Oral morphine to oral oxycodone?
/2
1167
Oral oxycodone to SC oxycodone?
/2
1168
Oral morphine to SC alfentanil?
/30
1169
Oral morphine to SC diamorphine?
/3
1170
12 fentanyl patch is how much morphine?
30mg
1171
10 buprenoprhine patch is how much morphine?
24
1172
PD end of life?
Rotigotine patch
1173
If midazolam ineffective for agitation in end of life?
Levomepromazine
1174
Treatment of hiccups in end of life?
Chlorpromazine
1175
Liver capsular pain?
Dexamethasone
1176
What increases mortality in dementia?
Antipsychotics
1177
When to add on memantine?
MMSE <10
1178
LDH is the tumour marker for?
Testicular ca NHL HL
1179
S-100 is the tumour marker for?
Melanoma Schwannoma
1180
B-2 microglobulin is the tumour marker for?
NHL Myeloma
1181
Seminoma testicular cancer tumour markers?
LDH HCG
1182
Etoposide chemotherapy can cause?
AML
1183
Hormonal therapy in breast cancer which is ER+ve?
Tamoxifen pre-menopausal Anastrozole post menopausal
1184
Trastuzumab is?
Herceptin
1185
Germ cell ovarian tumours tumour markers?
AFP HCG
1186
What is a krukenberg tumour?
Ovarian tumour met from GIT with signet ring morphology
1187
Asbestosis increases risk of what female GU cancer?
Ovarian
1188
Cervical cancer linked to?
HPV 16+18
1189
Never biopsy what cancer?
Testicular cancer promotes lymphatic spread
1190
SLE is associated with which DAT +ve haemolytic anaemia?
Warm autoimmune haemolytic anaemia
1191
What is defective in Chronic granulomatous disease?
Neutrophils
1192
ALL good prognosis?
Hypodiploidy
1193
CLL diagnosis?
Immunophenotyping
1194
What is deficient in Hereditary angioedema?
C1-INH deficiency
1195
Polycythaemia rubra vera can progress to?
Myelofibrosis AML
1196
Causes of drug induced methaemoglobinaemia ?
antimalarials (chloroquine, atovaquone) co-trimoxazole dapsone local anaesthetics (benzocaine, lidocaine)
1197
What is DDAVP?
Desmopressin
1198
What is the mechanism of action of desmopressin in VWD?
release of von Willebrand's factor from endothelial cells
1199
Lung cancer in non smokers?
Adenocarcinoma
1200
Adenocarcinoma of lung is found?
Peripherally
1201
Why do you get repeated infections in CLL?
hypogammaglobulinaemia low IgA/ IgG/IgM
1202
normocytic anaemia, gallstones and family history?
Hereditary spherocytosis
1203
Poor prognosis in Hodgkins lymphoma?
B symptoms Weight loss Night sweats Fver
1204
Bone marrow/ stem cell transplant blood transfusions ensure you request?
Irradiated
1205
CMV negative blood needed for?
Granulocyte transfusions Intra-uterine Neonates til 28 days Pregnancy
1206
Cisplatin mode of action?
cross-linking in DNA
1207
6th CN palsy?
False localising effect Raised ICP
1208
Management of acute angle closure glaucoma?
IV acetazolamide/ timolol + Peripheral laser iridotomy
1209
What prevents posterior synechiae?
Atropine or cyclophntolate
1210
Episcleritis blanches with?
Pressure 10% phenylephrine
1211
2 signs of central retinal artery occlusion?
Cherry red spot Pale retine
1212
Where is the occlusion in amourosis fugax?
Internal carotid artery
1213
ARMD has?
Metamorphsia and drusen
1214
Orbital cellulitis is?
Reduced VA RAPD Ptosis Painful eye movements Reduced colour vision
1215
Retinoblastma has?
White pupil- leukcoria
1216
Impaired light reaction to pupil but accomodation intact?
Argyll robertson
1217
APD is called?
Marcus gunn pupil
1218
Worst prognosis in age related macular degenration?
Wet
1219
RA has increased risk of what eye condition?
Keratoconjunctivitis sicca Dry eyes
1220
Strongest risk factor for age related macular degernation?
Smoking
1221
Mechanism of action of pilocarpine?
muscarinic receptor agonist increasing outflow
1222
Holmes aide pupil seen as?
Women Absent leg reflexes Dilated pupil Benign
1223
Mechanism of action of Dorzolamide?
Carbonic anhydrase inhibitor decreasing production
1224
Treatment of Herpes zoster ophthalmicus (HZO)?
Oral aciclovir
1225
Cause of horners syndrome that is post-ganglionic lesion?
Internal carotid artery
1226
Scleritis and episcleritis which is painful?
Scleritis
1227
Antioxidants not in?
Smokers increased risk of lung ca
1228
In panretinal photocoagulation what % of patients reports decreased visual field?
50%
1229
How is Central retinal vein occlusion seen?
sudden painless loss of vision, severe retinal haemorrhages on fundoscopy
1230
What is a monoclonal antibody directed against vascular endothelial growth factor (VEGF)?
Bevacizumab
1231
Anhydrosis in horners absent in?
Carotid artery dissection
1232
Causes of erythema nodosum?
IBD Bechets Sarcoidosis COCP TB
1233
Causes of erythema mutliforme (target lesions)
HSV EBV HIV
1234
Cellulitis cause?
Staph aureus Strep pyogenes
1235
Cause of erysipelas?
Group A B haemolytic strep
1236
Treatment of lymes?
Doxycyline
1237
Treating lymes can cause?
Jarisch-herxheimer reactions
1238
HSV-1
Cold sores
1239
HSV-2
Genitals
1240
Syphillis treatment?
Penicillin
1241
Tinea under woods lamp?
Bright green
1242
Actinic keratosis?
5-flourouracil
1243
Bowens in immuncompromised?
2ww
1244
Lichen planus?
P's Wickman striae
1245
Bullous pemphigoid?
Deep Subepidermal IgG to hemidesmosomes spares mucous membranes
1246
Pemphigus vulgaris?
Superficial Intraepithelial- desmoglein 3 IgG Mucous membranes and nikolsky +ve
1247
Photosensitive rash to dorsum of hands and face, associated with hair growth and pigementation?
Porphyria cutanea tarda
1248
What is the cause of porphyria cutanea tarda?
uroprophyringen decarboxylase
1249
Findings in uroporphyrinogen decarboxylase deficiency (inherited) porphyria cutanea tarda?
Pink urine under woods light High ferritin
1250
What else can cause prophyria cutanea tarda?
Inherited Alcohol Hep C Oestrogen
1251
Steroid ladder:
Mild: 1% hydrocortisone Moderate: clobetasone butyrate 0.05% Potent: betamethasone 0.1%
1252
Seborrhoeic dermatitis is associated with?
HIV Parkinsons disease Blepharitis
1253
What medication can worsen psoriasis?
BB
1254
Lichen planus oral involvement?
Commonly
1255
Dermatitis herpetiformis biopsy?
IgA deposition in the dermis
1256
Hirtusim treatment?
Topical eflornithine
1257
Lichen planus treatment?
Topical steroids
1258
Acne abx in pregnancy?
Erythromycin
1259
Isotretinoin SE?
teratogenicity low mood dry eyes and lips raised triglycerides hair thinning nose bleeds
1260
Non healing painless ulcer over site of trauma?
SCC
1261
Dermatitis in hands, lips and perianal?
Zinc deficiency
1262
Deep red ulcers with violaceous ulcer?
Pyoderma gangrenosum
1263
Alopecia accreta treatment?
Corticosteroid topical
1264
Flexural psoriasis first line treatment?
Topical steroids
1265
Hazard ratio is?
Survival over time
1266
Clinical trails stage 0-4?
0- exploratory 1- safety in healthy volunteers 2- dosing and efficacy 3- compare to standard 4- post marketing
1267
What are confounding variables?
Non random distribution of risk factors
1268
What is linear regression?
Predicts how much one variable changes when you change another y = bx +a
1269
Nominal data is?
Categories not in order e.g., birthplace
1270
Ordinal date is?
Categories with order e.g.,HF classification
1271
Discrete data is?
Finite number e.g., no. of asthma excacerbations
1272
Continuous data is?
range e.g., weight
1273
Interval data is?
Range with no true 0 e.g., temperature
1274
Why is a funnel plot used?
Determine publication bias, unsymmetrical = bias
1275
Incidence is?
No of new cases in a population over a period of time
1276
What does intention to treat analysis remove?
Drop out bias
1277
Type 1 error?
Incorrectly rejecting the null when it is true
1278
Type 2 error?
Incorrectly accepting the null when it is false
1279
Power =
1 - probability of a type 1 error
1280
Cohort study is?
Observational and prospective
1281
case control study is?
Observational and retrospective with matched control
1282
Cross sectional study is looking at?
Prevelance
1283
Normal distribution is?
Mean = Median = Mode
1284
SD =
Sqaure root of variance
1285
Standard error of mean =
SD / square root of n
1286
95% CI is?
1.96 SD from mean
1287
SD's numbers:
1- 68.3% (34 each side) 2- 95.4% 3- 99.7%
1288
When do you use parametric tests?
Normal distributions Quantative data Means and SD
1289
Name the 2 parametric tests?
Students t-test (paired, unpaired) Pearson's coefficient (correlation)
1290
What is a paired test?
Looks at one group with 2 values
1291
What is an unpaired test?
Two different groups
1292
When do you use a non parametric test?
Skewed, qualitative (nominal/ordinal)
1293
Name the 4 non parametric test?
Mann whitney U- unpaired Wilcoxon signed rank- paired Chi squared- proportions, % Spearman's
1294
How do you remember which non parametric test if paired or unpaired?
Mann Whitney U- whitney houston is not a man so unpaired Wilcoxon- will is a man with a cox so paired
1295
Sensitivity?
TP/TP + FN
1296
Specificity?
TN/ TN+ FP
1297
PPV?
TP / TP + FP
1298
NPV?
TN/ TN + FN
1299
NNT =
1 / ARR
1300
ARR is?
Absolute risk reduction Control incidence - experimental incidence
1301
RRR?
Control incidence - experimental incidence ------------------------------------------------------ Control incidence
1302
Risk ratio =
Experimental incidence / control incidence
1303
Odds ratio =
AD / BC
1304
Tuberous sclerosis inheritance?
AD
1305
Action of Vit D?
Increased calcium absorption in gut Increases phosphate
1306
Action of ADH?
Acts on collecting ducts to increase water reabsoprtion by increasing aqauporin 2 channels
1307
What is penetrance?
Having the allele but no the phenotype
1308
Chi sqaured for?
Non parametric nominal data
1309
Tay sachs and Neiemann-Pick syndromes?
Developmental delay Cherry red spot on macula Neiemann- + hepato/splenomegaly
1310
Tall with downward lens dislocation, DVT, tall, learning difficulties?
Homocsytinuria
1311
X linked recessive conditions?
Duchennes Beckers Haemophilla G6PD Colour blindness Fabrys
1312
Trinucleotide repeat disorders?
Huntingtons Freidrichs ataxia Myotonic dystrophy Fragile X syndrome
1313
Vitamin B3 is?
Niacin
1314
What is niacin deficiency?
Pellegra
1315
How is pellegra/ Niacin (B3) deficiency seen?
Dermatitis Dementia Diarrhoea
1316
HLA's are always on which chromosome?
6
1317
What secretes GH?
Somatotropin cells
1318
What does GH directly act on?
Chondrocytes and osteoblasts
1319
What hormone is an anabolic steroid?
GH
1320
What does insulin bind to?
Tyrosine kinase receptors
1321
HIV progression is seen by increased?
B3 microglobulin
1322
2 actions of nitrates?
Smooth muscle relaxation causing vasodilation Inhibits plt aggregation
1323
Mitochondrial diseases show poor?
Penetrance
1324
What receptor does EBV bind to?
CD21
1325
Th cells secrete?
IL-4
1326
TNF is secreted by?
Macrophages
1327
NK cells secrete?
Interferon gamma
1328
What increases iron absorption in the gut?
Vit C (asorbic acid)
1329
Treatment of minimal change disease?
Steroids
1330
Triad of von hippel lindau?
Retinal and cerebellar haemogioblastoma Clear cell renal carcinoma
1331
Post STEMI anti plt?
DAPT Ticagrelor + aspirin
1332
Enterobius vermiacaris?
Threadworm in children
1333
Taenia solium?
Pork tape worm
1334
Drugs causing peripheral neuropathy?
Vincristine Amiodarone Isoniazid Nitrofuratoin Metronidazole
1335
Indinavir causes?
Nephrolithiasis
1336
2 signs of spontaneous CJD?
Rapidly progressive mental deterioration Myoclonus (often startle)
1337
AED in breatfeeding?
All OK
1338
Mixed alpha and beta adrenoceptor?
Carvedilol
1339
Choice of intervention for severe MS in young?
Percutaneous mitral commissurotomy
1340
Choice of intervention for severe MS in old with calcification?
Replacement
1341
Antibiotic for legionella?
Clarithromycin Legion = camp, camp= gives clarity
1342
Action of clarithromycin?
Inhibits protein synthesis
1343
NF1 findings?
Multiple neurofibromas Cafe au lait spots Lisch nodules Optic gliomas
1344
NF2 findings?
schwannomas and meningiomas
1345
alexia (inability to read) is associated with lesion to the?
Corpus callosum
1346
How do you offer HPV vaccination to?
MSM <45 to protect against anal, throat and penile cancers
1347
Disseminated lymes treatment?
IV ceftriaxone
1348
Mantoux and inferon +ve with no symptoms?
Latent TB
1349
Management of latent TB?
3 months of isoniazid + pyridoxine + rifampicin 6 months of isoniazid with pyridoxine
1350
Chikungunya symptoms?
Severe joint pain
1351
Causes of occupational asthma?
isocyanates platinum salts soldering flux resin glutaraldehyde flour epoxy resins proteolytic enzymes
1352
Nightmares?
Bisoprolol
1353
Risk factors of aloopurinol SJS?
Diuretic use Ethnicity (Thai descent) Chronic kidney disease
1354
IE abx til sensitivities return?
Amoxicillin and gentamicin
1355
How long eating gluten for diagnostic tests?
6 weeks
1356
Rapidly spreading rash from buttocks up?
Strongyloides stercoralis
1357
Management of Strongyloides stercoralis?
Ivermectin
1358
UC with severe relapse or 2+ exacerbations in past year treat with?
oral azathioprine or oral mercaptopurine
1359
Raised inflammatory markers in UC severity?
Severe
1360
Triggers for cluster headache?
Alcohol
1361
Amiodarone rash?
Photosensitive rash on arms and face
1362
Affect of amiodarone on the eyes?
Corneal opacities Optic neuritis
1363
What is uncommon in drug induced lupus?
Glomerulonephritis
1364
Organophosphate insecticide poisoning tx?
Atropine
1365
Treatment of fast AF in WPW?
Flecanide Avoid anything that inhibits AVN conduction AVN: CCB, BB, digoxin due to risk of VF
1366
SEs of phenytoin?
Gingival hyperplasia Peripheral neuropathy Hirsutism Coarsening of facial features Megaloblastic anaemia Osteomalacia Lymphadenopathy Dyskinesia
1367
Filariasis that is brawny and indurated?
Wuchereria bancrofti
1368
Statins or ezetimibe in pregnancy/ trying to conceive?
NO STOP
1369
Medication overuse headache treatment?
Slowly decrease opioids, stop NSAID and paracetamol now
1370
Marfans optic issue?
Superotemporal ectopia lentis (upward lens dislocation)
1371
First line for neuropathic pain?
Amitriptyline
1372
Second line for neuropathic pain, when amitriptyline contraindicated due to BPH/ risk of urinary retention?
Pregabalin
1373
Kallman vs Klienfelter?
Both low testoesterone Kallman Low LH and FSH, no smell Klienfelters High LH and FSH
1374
Gitelman's affects the?
DCT
1375
Granuloma inguinale is due to?
Klebsiella granulomatis
1376
What is a chancroid?
Haemophilus ducreyi. painful genital ulcers, painful inguinal lymph node enlargement.
1377
What is Lymphogranuloma venereum (LGV)?
Chlamydia trachomatis. small painless pustule which later forms an ulcer
1378
Medications linked to poor glycaemic control?
thiazides steroids tacrolimus, ciclosporin interferon-alpha nicotinic acid antipsychotics
1379
Parietal lobe lesions can cause?
Astereognosis Inability to recognise things
1380
Ethyl gycol poisoning on ABG?
RAGMA and high osmolar gap
1381
Mechanism of action of sumitriptan?
5-HT1 agonist
1382
Mechanism of action of pilocarpine for dry mouth?
Muscarinic agonist
1383
Steroids can cause?
Drug adverse effect of acne like spots
1384
Adverse effect of long term steroids?
Avascular necrosis
1385
centrally acting anti hypertensive?
Moxonidine
1386
Associations with WPW?
HOCM mitral valve prolapse Ebstein's anomaly thyrotoxicosis secundum ASD
1387
Shift to the R in oxygen dissociation curve?
Raised [H+] (acidic) Raised pCO2 Raised 2,3-DPG Raised temperature
1388
Drugs causing urticaria?
aspirin penicillins NSAIDs opiates
1389
Causes of restrictive cardiomyopathy?
Amyloidosis (most common), Haemochromatosis Loffler's syndrome Sarcoidosis Scleroderma
1390
Ankylosing spondylitits is associated with which valvular problem?
Aortic regurg
1391
William syndrome is associated with?
Supravalvular AS
1392
Reversal of dabigatran?
idarucizumab
1393
Drug causes of intracranial HTN?
combined oral contraceptive pill steroids tetracyclines Isotrenonin lithium
1394
Gram negative cocci?
Neisseria meningitidis Neisseria gonorrhoeae Moraxella catarrhalis
1395
What is Gerstmann syndrome?
acalculia right-left disorientation finger agnosia agraphia
1396
Where is the lesion in Gerstmann syndrome?
Dominant parietal lobe
1397
tirofiban pre PCI mechanism of action?
Glycoprotein IIb/IIIa receptor antagonis
1398
Early x-ray feature of RA?
Juxta-articular osteoporosis/osteopenia
1399
T2DM not controlled on triple therapy?
switch one of the drugs for a GLP-1 mimetic, particularly if the BMI > 35
1400
T wave inversion in V1-3 with notch at end of QTc (AKA epsilon wave)?
Arrhythmogenic right ventricular cardiomyopathy
1401
Protein on urine dip on kidney dysfunction rules out?
Pre or post renal causes
1402
Psoriatic arthritis affects?
Males and female equally
1403
72 hours post op without pyrexia with new o2 requirement think?
Atelectasis
1404
If you cant give ciprofloxacin to meningitis contacts give?
Rifampicin
1405
Can mothers with Hep B breast feed?
Yes
1406
How to look after baby born to mother with Hep B?
At birth hepatitis B immunoglobulin (HBIG) within 24h hepatitis B vaccine
1407
Bile acid malabsorption test?
SeHCAT
1408
What are the risk factors for oesophageal adenocarcinoma?
Barrett's oesophagus Smoking Alcohol
1409
What are the risk factors for oesophageal squamous cell carcinoma?
Smoking Alcohol Plummer vinison Achalasia
1410
PCP on examination?
Very little chest signs to auscultate
1411
Recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with?
oral fidaxomicin
1412
AD PCKD type 1 chromosome?
chromosome 16
1413
AD PCKD type 2 chromosome?
Chromosome 4
1414
Gitelman's syndrome mechanism?
NaCl symporter in the DCT
1415
Suspect meningitis start?
cefotaxime IV
1416
Plasma exchange complication?
Hypocalcaemia as it is chelated by sodium citrate, the agent used as an anticoagulant during the procedure
1417
Mechanism of action of procyclidine?
Anti muscarinic
1418
Treatment of Varicella pneumonia?
IV aciclovir
1419
Warfarin in breast feeding?
YES fine
1420
What abx inhibit protein synthesis?
Clarithromycin Erthromycin Gentamicin Doxycycline
1421
Delayed gastric emptying can be seen in?
Migraine
1422
SLE disease monitoring?
Anti-dsDNA titres
1423
Hodgkin lymphoma has which CD?
CD15
1424
What type of hypersenstivity reaction is ITP?
Type II
1425
HLA DR2?
Good pastures
1426
Friedrichs ataxia?
AR - recessive
1427
Large pulse pressure in older age is due to? (difference between systolic and diastolic)
reduced aortic compliance
1428
HLA- DRB1?
Rheumatoid arthritis
1429
Turners syndrome cardiac problems?
aortic dilatation and dissection
1430
Vincristine acts during which cell cycle phase?
metaphase
1431
What is the normal action of p53?
preventing entry into the S phase until DNA has been checked and repaired
1432
When proteins in the cell have been marked with ubiquitin they go to the?
Proteasome ubiquitin-proteasome system (UPS)
1433
How do you calculate likelihood ratio of a positive test?
sensitivity / (1- specificity)
1434
Central chemoreceptors work due to?
pH
1435
Turners syndrome associated with which cardiac defect?
Coarctation of the aorta Aortic dilatation Aortic dissection
1436
Vincristine acts on which cell cycle?
metaphase
1437
What is the normal action of p53?
Preventing entry into the S phase until DNA has been checked and repaired
1438
Large pulse pressure in older age is due to?
Reduced aortic compliance
1439
HLA-DRB1?
Rheumatoid arthritis
1440
Homocystinuria is caused by a deficiency of?
cystathionine beta synthase
1441
Cubital tunnel syndrome affects which nerve?
Ulnar
1442
How to remember molecular tests?
SNOW DROP South, North, West DNA, RNA, proteins
1443
Action of NO?
vasodilation + inhibits platelet aggregation
1444
RNA splicing occurs in the?
Nucleus
1445
Cardiac issues in downs syndrome?
endocardial cushion defect (AVSD) VSD Secundum atrial septal defect tetralogy of Fallot isolated patent ductus arteriosus
1446
Wrist drop seen due to injury to?
Radial nerve
1447
Hypothenar wasting?
Ulnar nerve
1448
Pain and temp are in the?
Spinothalamic tract
1449
Pain and temp of spinothalamic cross?
at level of spinal cord - what you have to respond quickly to
1450
Hypotension in sepsis due to?
IL-1
1451
Activation of B cells via?
IgD
1452
Name the 4 steps of cardiac action potential?
4- resting Na/K ATPase 0- depolarisation- Na IN 1- early repolarisation- K out 2- plateau Ca slowly in 3- repolarisation- K out
1453
Hypersensitivity reactions?
1- anaphylaxis IgE 2- Cell bound 3- immune complex SLE, PSGN 4- delayed scabies Allergic dermatitis GvHD TB
1454
Where does levothyroxine act?
Nuclear receptors
1455
What does digoxin do to the QT interval?
Shortens it
1456
What does digoxin act on?
Na/K ATPase
1457
Digoxin toxicity is more likely in which electrolyte disturbance?
HypoK
1458
Cyanaid poisoning treat with?
Hydroxocobalamin (b12)
1459
Metformin mechanism of action?
activation of the AMP-activated protein kinase (AMPK)
1460
Alcohol in a paracetamol overdose?
Protective
1461
What increases the risk of lithium toxicity?
Thiazides ACEi
1462
Cocaine causes what temp chnage?
Hypertehermia
1463
Furosemide may cause hypo?
Hypo Mg
1464
When do you take lithium levels?
12 hours post dose
1465
Treatment within an hour of aspirin overdose?
charcoal
1466
TIA confirmed medications?
Aspirin + clopidogrel
1467
Test for family members of haemochromatosis?
HFE gene
1468
Large jaw tumour?
Burkitts lymphoma
1469
Burkitts lymphoma translocation?
8:14
1470
S4 is inkeeping with?
P wave
1471
Spike and dome appearance on renal biopsy?
Idiopathic membranous glomerulnephritis
1472
Antibodies in idiopathetic membranous glomerulonephritis?
Anti-phospholipase A2 antibodies
1473
Drug induced lupus medication aganist TB?
Isoniazid
1474
Good pastures defective of which collagen?
Collagen IV
1475
What activates macrophages?
Interferon- y
1476
Treatment of GAD?
SSRIs
1477
Purplish macules in HIV+ve?
kaposi sarcoma
1478
What virus is causing kaposi sarcoma in HIV +ve pts?
HHV-8
1479
What produces somatotrophin?
D cells
1480
What causes eczema herpiticum?
HSV-1 Cocksakie
1481
Widening of wrists?
Rickets
1482
What decreases levotyroxine if taken together/ within 4 hours?
Ion and calcium
1483
What causes congenital adrenal hyperplasia?
21-hydroxylase deficiency
1484
Basilar artery stroke?
Locked in syndrome
1485
Amurosis fugax?
retinal or opthalamic artery
1486
Gynaecomastia can occur in?
Digoxin
1487
Poor prognosis in MS?
Male
1488
Psoriasis is worsened by which drugs?
Hydroxychloroquine Lithium
1489
Japanese encephalitis affects the?
Basal ganglia (PD signs in encephalitis)
1490
Methaemoglobinaemia is the?
oxidation of Fe2+ in haemoglobin to Fe3+
1491
What causes hirtusim?
Phenytoin
1492
Where is the medial longitundial fasiculus?
Paramedian midbrain and pons
1493
Which treatment for osteoporosis is a RANKL inhibitor?
Denosumab
1494
What chromsome is affected in NF2 with bilateral schwanomas?
Chromosome 22
1495
What is the most common cause of inherited colon cancer?
HNPCC (lynch)
1496
Seborrhoic dermatitis is more common in?
PD HIV
1497
What test do you do for prognosis of AML?
Cytogenetics
1498
Which infection causes rash sparing hands and feet?
Thyphus
1499
How do you treat tyhpus?
Doxcycline
1500
Long QT syndrome is caused by?
Loss of function of K cells
1501
Ulcer with purple violaceous border?
Pyoderma gangrenosum
1502
What is the treatment of pyoderma gangrenosum?
Steroids
1503
What is the inheritance of charcot marie tooth?
AD
1504
Phenytoin causes macrocyctic anaemia by?
Folate deficiency
1505
Biopsy of HSP renal?
Mesangial hypercellularity
1506
Which antibiotics inhibit 50S?
Macrolides Clarithromycin, erythromycin

MRCP Part 1 (3 decks)

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