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Cardiology > 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
Q

CT head with numerous small calcifications after travel abroad?

A

Neurocysticosis

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26
Q

What is Fabry disease?

A

Deficiency of alpha galactosidase A

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27
Q

How does Fabry disease present?

A

High urine protein and albumin
Angiokeratomas to trunk
Burning pain to hands and feet
Dark urine after exercising

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28
Q

Gilteman syndrome?

A

Normotension
Metabolic alkalosis
Hypokalaemia
Hypocalciuria

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29
Q

Bartter syndrome?

A

Normotension
Metabolic alkalosis
Hypokalaemia
HYPERcalciuria

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30
Q

Hyperaldoesteronism?

A

Hypertension
HyperNa

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31
Q

Neuropathic pain means not working next step?

A

Monotherapy, stop one and try another

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32
Q

Blistering rash including mucous membranes?

A

Pemphigus vulgaris

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33
Q

New diagnosis of dermatomyositis investigation?

A

Malignancy check

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34
Q

Dermatomyositis presentation?

A

Helicotrope rash
Gottrons papules
Proximal myopathy
High CK

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35
Q

Octreotide mode of action?

A

Somatostatin analogue

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36
Q

Carcinoid syndrome treatment?

A

Octreotide

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37
Q

What avoids graft vs hots disease for blood products?

A

Irradiation

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38
Q

Heparin induced thrombocytopenia antibodies?

A

Against heparin and platelet factor 4

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39
Q

Friedrichs ataxia seen with:

A

Ataxia
Nystagmus
Cardiomyopathy
High arched palate
Optic atrophy
DM

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40
Q

Inheritance of Friedrichs ataxia?

A

AR

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41
Q

Cause of friedrichs ataxia?

A

Trinucleotide repeat

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42
Q

Malt workers lung?

A

Aspergillus clavatus

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43
Q

Hereditary angioedema test?

A

C4 levels
No histamine involved

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44
Q

Subacute degeneration of the cord affects the?

A

Lateral corticospinal tracts and dorsal coloumns

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45
Q

Traveller came home with persistent fever, rash sparing soles and palms, retroorbital headache and myalgia?

A

Dengue fever

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46
Q

Ancanthosis nigricans rash?

A

Gastric adneocarcinoma
Hypothyroidism
Prader-Willi
PCOS
DM
Steroids

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47
Q

Treatment of acromegaly?

A

Surgery
If refractory Octreotide, Pegvisomant

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48
Q

Mode of action of pegvisomant?

A

GH receptor antagonist

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49
Q

Listeria in CSF abx change?

A

Amoxicillin + gent

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50
Q

HLA-B5801

A

High risk of allopurinol induced SJS

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51
Q

Hungry bone syndrome

A

Sudden drop is PTH

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52
Q

Verapamil is contraindicated in?

A

Ventricular tachycardia

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53
Q

last

A

Last

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54
Q

Laxative for opioids?

A

Senna

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55
Q

Anti Emetic for chemotherapy

A

Ondansetron

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56
Q

Action of Ondansetron?

A

5HT3

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57
Q

Valvular disease in carcinoid?

A

Pulmonary stenosis

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58
Q

Pregnant women abx for UTI

A

Nitrofurantoin (except 3rd trimester- cefalexin)
Pen allergic trimethoprim

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59
Q

Murmurs memory aid

A

MR PAN
MS MD
AR ED

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60
Q

Frequent NSAID with mild eosinophilia, rash and arthralgia?

A

Acute interstitial nephritis

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61
Q

Restless legs treatment?

A

Ropinirole

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62
Q

Sildenafil mode of action?

A

PDE 5 inhibitor

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63
Q

What is contraindicated with Sildenafil?

A

Nitrates and Nicorandil

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64
Q

Anti-Yo linked to?

A

Breast and ovarian Ca
Cerebellar syndrome

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65
Q

MRI for MS?

A

MRI FLAIR

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66
Q

MRI for thyroid eye disease?

A

MRI STIR

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67
Q

NIV not recommended in?

A

Bronchiectasis

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68
Q

NIV ph for COPD?

A

<7.25

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69
Q

Bacterial infection in unpasteurised milk/ cheese?

A

Brucella

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70
Q

Antibiotic that increases the risk of MRSA?

A

Ciprofloxacin

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71
Q

SLE most common antibody?

A

ANA

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72
Q

SLE most common antibody?

A

ANA

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73
Q

Non specific urethritis?

A

Doxycycline 1 week

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74
Q

Mechanical aortic valve INT target?

A

3

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75
Q

Mechanical mitral valve INR target?

A

3.5

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76
Q

Travellers diarrhoea?

A

E. Coli

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77
Q

Ketamine mode of action?

A

NMDA receptor antagonist

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78
Q

Adrenaline mode of action?

A

G protein coupled receptor

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79
Q

Gosh and seafood poisoning?

A

Mercury

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80
Q

Visual defects, hearing loss and paraesthesia poisoning?

A

Mercury

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81
Q

Visual defects, hearing loss and paraesthesia poisoning?

A

Mercury

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82
Q

VBG of renal tubular acidosis?

A

NAGMA

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83
Q

Oropharyngeal cancer cause?

A

HPV 16+18

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84
Q

AML poor prognosis?

A

Deletion 5 and 7

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85
Q

Chemo agent causing hypoMg?

A

Cisplatin

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86
Q

SGLT2 inhibitor SE?

A

Fourniers gangrene

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87
Q

SGLT2?

A

Gliflozins

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88
Q

SGLT2?

A

Gliflozins

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89
Q

What secretes surfactant?

A

Type 2 pneumocysts

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90
Q

How long to monitor anaphylaxis after?

A

At least 2 hours

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91
Q

Does SJC have mucosal involvement?

A

Yes

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92
Q

What is dermatitis herpetiformis?

A

Autoimmune papules and pustules on extensors, pruritic

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93
Q

What is dermatitis herpitformis linked to?

A

Coeliac disease

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94
Q

One single ring enhancing lesion on CT Brain?

A

Abscess

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95
Q

Abx for brain abscess?

A

Ceftriaxone + metronidazole

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96
Q

What is lead time bias?

A

new investigation method diagnoses early but no effect on outcome

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97
Q

Perioxisomes action?

A

catabolism of long chain fatty acids

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98
Q

What are the indications for steroids in sarcoidosis?

A

parenchymal lung disease, uveitis, hypercalcaemia, neuro/ cardiac involvement.

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99
Q

Anti Hu antibodies seen in and with what?

A

Small cell lung cancer
Painful sensory neuropathy
Cerebellar syndrome

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100
Q

Stain and sign for Cryptosporidium?

A

modified ZN stain - red cysts

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101
Q

What is Kartanger syndrome?

A

primary ciliary dyskinesia

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102
Q

How is kartanger syndrome seen?

A

Dextrocardia, chronic sinusitis, bronchiectasis, male sub fertility

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103
Q

Renal complication of Tuberous sclerosis?

A

renal angiomyolipomata prone to haemorrhage

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104
Q

ABG seen in Cushings?

A

hypokalaemic metabolic alkalosis, due to sodium and water retention

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105
Q

Causes of Eczema herpeticum?

A

HSV
Cocksakie virus

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106
Q

Action of Secretin?

A

Secretin promotes bicarbonate secretion in GIT

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107
Q

What causes cat scratch disease?

A

Bartonella

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108
Q

Staining in cat scratch disease?

A

Wartharin-starry staining

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109
Q

Presentation of cat scratch disease?

A

regional ipsilateral lymphadenopathy

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110
Q

High C-peptide?

A

High c-peptide endogenous insulin

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111
Q

Low C-peptide?

A

Low c-peptide means insulin exogenous

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112
Q

What is Pulsus alternans?

A

alternating strong and weak pulse in severe LVF

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113
Q

What is Pulsus paradoxes?

A

fall of BP on inspiration in cardiac tamponade

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114
Q

How do you treat Adrenaline induced ischaemia?

A

phentolamine

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115
Q

What is the mechanism of action of Timolol?

A

Timolol reduces aqueous production in open angle closure glaucoma

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116
Q

What can Polycyanthemia Vera progress to?

A

AML

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117
Q

Mode of inheritance of Peutz-jeghers syndrome?

A

AD

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118
Q

What is Peutz-jeghers syndrome?

A

AD haemartomas in GIT leading to colon cancer seen with pigmented freckles on lips, face, palms

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119
Q

Malaria with shortest erythrocytic replication cycle leading to high parasite count in short period of time

A

plasmodium knowlesi

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120
Q

Dermatomyositis most common antibody?

A

ANA

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121
Q

Dermatomyositis most specific antibody?

A

Anti Mi 2

Or Anti Jo-1

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122
Q

Which anti malarial to avoid in G6PD?

A

Primaquine avoid in G6PD

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123
Q

Treatment of oculogyric crisis?

A

Procyclidine

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124
Q

What is 11-beta hydroxylase deficiency?

A

congenital adrenal hyperplasia with excess DOC

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125
Q

What is 11-beta hydroxylase deficiency associated with hypertension/ normotension?

A

Hypertension
HypoK

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126
Q

What is Wiskott-Aldrich syndrome?

A

Combined B- and T-cell disorders

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127
Q

What produced gastrin?

A

G cells in antrum of stomach

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128
Q

Stroke of anterior cerebellar artery?

A

Contra-lateral hemiparesis
Sensory loss
Lower limb > upper

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129
Q

Stroke of middle cerebral artery?

A

Contra-lateral hemiparesis
sensory loss
Upper > lower
Homonymous hemianopia
Aphasia

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130
Q

Posterior cerebellar artery stroke?

A

Contra-lateral homonymous hemianopia with macular sparing
Visual agnosia

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131
Q

Webers syndrome?

A

Stroke of branch of posterior cerebral artery supplying the midbrain

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132
Q

Weber’s syndrome presentation?

A

Ipsilateral CN palsy
Contra-lateral weakness in upper and lower limbs `

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133
Q

Posterior inferior cerebellar artery stroke AKA?

A

Wallenberg syndrome
Lateral medullary syndrome

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134
Q

What is wallenberg syndrome?

A

Ipsilateral facial pain and temp loss
Contralateral limb/ torso pain and temp loss
Ataxia and nystagmus

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135
Q

Anterior inferior cerebellar (lateral pontine syndrome) signs?

A

Ipsilateral facial paralysis
Deafness

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136
Q

India ink for?

A

Cryptococcal

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137
Q

Reduce risk of calcium renal stones medication?

A

Thiazides

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138
Q

MRI head non enhancing multiple lesions?

A

JC virus

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139
Q

Primary central nervous system lymphoma on MRI?

A

HIV CD4 <50 multiple enhancing lesions with oedema and mass effect

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140
Q

Hazard ratio meaning?

A

Analysing survival over time

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141
Q

Action of Buprenoprhine?

A

partial agonist of the mu-opioid receptor and an antagonist of the kappa-opioid receptor

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142
Q

What is De Quervains tenosynovitis?

A

inflammation of the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons

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143
Q

What is a nonsense mutation?

A

A mutation that results in a stop codon

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144
Q

Ticagrelor mode of action?

A

Inhibits ADP binding of platelet receptors

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145
Q

Donepezil SE?

A

Insomnia

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146
Q

Pre diabetes diagnosis?

A

fasting 6.1-6.9
HbA1c 42-47

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147
Q

Impaired fasting glucose?

A

6.1 to <7

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148
Q

Impaired glucose tolerance?

A

Fasting <7 and OGTT 7.8+ <11.1

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149
Q

Cavitating lung cancer?

A

Squamous cell

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150
Q

Management of bleeding in VWF?

A

Desmopressin

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151
Q

Livedo reticularis rash (lace like) in?

A

SLE
Cryoglobulinaemia
Anti phospholipid
Ehlers-Danlos syndrome

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152
Q

Muddy brown casts?

A

ATN

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153
Q

Ankylosing spondylitis x-ray?

A

Syndesmophytes

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154
Q

Von Hippel Lindau syndrome renal cancer?

A

Clear cell renal cell carcinoma

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155
Q

What is leptin?

A

Produced by adipose tissue and decreases appetite

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156
Q

Length for result of finasteride?

A

6 months

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157
Q

Staph aureus time to food poisoning?

A

4 hours

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158
Q

What does lichen planus look like?

A

P’s on flexors

Planus
Purple
Pruritic
papular
Polygonal
+ wickmans striae

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159
Q

Best data class- meta analysis?

A

1a

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160
Q

Dermatitis herpitformis and Sjogrens HLA?

A

HLA DR3

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161
Q

Behcets HLA?

A

HLA B51

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162
Q

T1DM HLA?

A

HLA DR4

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163
Q

Allergic bronchopulmonary aspergillosis tx?

A

Prednisolone

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164
Q

Rapid depolarisation cause?

A

Rapid sodium influx

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165
Q

Opioid for renal impairment?

A

Buprenoprhine

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166
Q

What is Trastuzumab?

A

Herceptin

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167
Q

What is the mode of action of herceptin/ trastuzumab?

A

HER2

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168
Q

Selegiline mode of action?

A

MAO-B inhibitor

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169
Q

LRTI with hypoNa?

A

Legionella

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170
Q

Ciclosporin levels timing?

A

Immediately before next dose

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171
Q

3 Anti HTN, K for next step?

A

> 4.5

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172
Q

3 anti HTN with K 4.6 next step?

A

Alpha blocker
Beta blocker

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173
Q

3 anti HTN with K 2.1?

A

Spironolactone

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174
Q

Bladder calcification?

A

Schistosoma haematobium

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175
Q

Rosacea treatment?

A

Topical ivermectin + oral doxycline

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176
Q

Source of folic acid?

A

Liver

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177
Q

S4?

A

Aortic stenosis
HOCM

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178
Q

S3?

A

Normal <30
LVF (dilated cardiomyopathy), MR, constrictive pericarditis

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179
Q

HIV linked to obstructive jaundice cause?

A

Sclerosing cholangitis

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180
Q

SE of hydroxychloroquine and monitoring as a result?

A

Retinopathy
Fundoscopy and VA

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181
Q

DiGeorge syndrome as defective?

A

T cells

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182
Q

Infection risk in DiGeorge?

A

Cryptococcus neoformans due to thymus hypoplasia

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183
Q

What is osteomalacia?

A

Vit D deficiency of adults
Low Ca and phosphate
High PTH
Looser zones

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184
Q

What is pagets?

A

Increased bone turnover
Isolated raised ALP

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185
Q

Drugs causing gingival hyperplasia?

A

Gums - gingival hyperplasia
Can- CCB (amlodipine, nifidipine)
Cause- Cyclosporin
Pain - Phenytoin
Alot- AML

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186
Q

Skin cancer in renal transplant?

A

SCC

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187
Q

Bicuspid aortic valve is associated with?

A

Coarctation of the aorta

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188
Q

Renal stones are most commonly?

A

Calcium oxalate

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189
Q

Pulmonary haemorrhage and nephritic syndrome think?

A

Goodpastures syndrome

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190
Q

What is good pastures syndrome?

A

anti GBM

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191
Q

Hereditary angioedema due to?

A

Bradykinin

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192
Q

Biopsy with subepithelial deposits, thickened capillary walls and nephrotic syndrome?

A

Membranous glomerulnephritis

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193
Q

Bladder cancer infection?

A

Schistosomiasis

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194
Q

Nasopharyngeal cancer linked to?

A

EBV

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195
Q

Stage 1 diabetic nephropathy?

A

Hyperfiltration and increase in eGFR

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196
Q

Stage 2 diabetic nephropathy?

A

eGFR elevated and latent

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197
Q

Stage 3 diabetic nephropathy?

A

Microalbuminuria

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198
Q

Stage 4 diabetic nephropathy?

A

Proteinuria >300 with diffuse glomerulsclerosis, and kimmelsteil wilson nodules

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199
Q

Stage 5 diabetic nephropathy?

A

ESRD

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200
Q

Epsilon waves in V1-3?

A

Arrthymogenic right ventricular cardiomyopathy (ARVD)

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201
Q

What is arrthymogenic right ventricular cardiomyopathy?

A

Replacement of R ventricle with fatty fibrous tissue

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202
Q

Risk of atypical anti psychotics in elderly?

A

VTE

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203
Q

Lights criteria for exudative effussion?

A

High protein/ serum protein >0.5
Fluid LDH / serum LDH >0.6
Fluid LDH > 3* normal

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204
Q

CRAB + raynauds seen in?

A

Type 1 cryoglobulinaemia

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205
Q

What is the action of troponin C?

A

Binding calcium to activate muscle contraction

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206
Q

Avascular necrosis of hip seen more in?

A

Chronic alcoholics

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207
Q

Primary biliary sclerosis linked to?

A

Sjrogens

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208
Q

Treatment of PBS?

A

Ursodeoxycholic acid

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209
Q

Features of ankylosing spondylititis?

A

A’s
- Apical fibrosis
- Anterior uveitis
- Aortic regurgitation
- Achilles tendonitis
- AV node block
- Amyloidosis

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210
Q

Which abx can prolong QTc?

A

Erythromycin

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211
Q

Eggshell calcification on scans in lung?

A

Silicosis (miners lung)

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212
Q

Miners lung is?

A

Silicosis

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213
Q

How do you calculate standard error of the mean?

A

SD / square root (no. pt)

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214
Q

Ashoff bodies seen in?

A

Rheumatic fever

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215
Q

What are ashoff bodies?

A

Granulomatous nodules in rheumatic fever

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216
Q

What is high ASOT?

A

Rheumatic fever

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217
Q

Infliximab action?

A

Anti TNF

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218
Q

Action of flecanide?

A

Blocks Na v 1.5 channels in the heart

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219
Q

What is associated with MALT lymphoma?

A

hashimotos thyroiditis

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220
Q

Hypothyroidism adjustment in pregnancy?

A

Increase up to 50%

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221
Q

Most common inherited thrombophilia?

A

Factor V leiden

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222
Q

How is Lesch-Nyhan syndrome passed on?

A

X linked recessive

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223
Q

How is lesch-nyhan seen?

A

Sand coloured, orange stools
Hyperuricaemia

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224
Q

Thrombectomy in stroke?

A

6-12 hours

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225
Q

Thrombolysis for stroke?

A

4.5h

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226
Q

Dentistry in warfarinised patients?

A

Check INR 72 hours before, proceed if <4

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227
Q

Good prognosis in GBS?

A

No diarrhoeal illness

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228
Q

Poor prognosis in GBS?

A

Anti GM1 high

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229
Q

X-ray findings of ankylosing spondylitits?

A

Syndesmophytes, subchondral erosions, sqauring of vertebrae

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230
Q

Mechanism of action of aspirin?

A

Inhibits thromboxane A2 production

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231
Q

Severe malaria?

A

Parastaemia >2%

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232
Q

Canon A waves JVP?

A

Complete heart block

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233
Q

Last stage of atherosclerotic plaque?

A

Smooth muscle proliferation and migration from media to intima

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234
Q

Screening for herediatry angioedema between attacks?

A

C4

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235
Q

Mechanism of action of aspirin?

A

Non reversible COX 1 and 2 inhibitor

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236
Q

Mechanism of action of docetaxel?

A

Prevents microtubule depolymerisation and dissasembly

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237
Q

Mechanism of action of buprenoprhine?

A

Partial agonist Mu- opioid receptors
Antagonism at kappa

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238
Q

Sitagliptin is a?

A

DDP-4 inhibitor

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239
Q

Effect of DDP-4 inhibitors e.g., sitagliptin on weight?

A

DONT cause weight gain

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240
Q

Haemolytic uremic syndrome triad?

A
  • Haemolytic anaemia (MAHA)
  • AKI
  • Thrombocytopenia
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241
Q

Causes of cranial DI?

A

Head injury
Pituitary surgery
Craniopharyngiomas
Sarcoidosis
Histiocytosis X
Hemochromatosis

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242
Q

Causes of nephrogenic DI?

A

Vasopressin receptor deficiency
Less common aqauporin 2 channel
HyperCa
HypoK
Lithium

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243
Q

Tetracyclines can cause what SE?

A

Photosensitive rash to face and neck

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244
Q

Crohn’s signs?

A

Inflammation of all layers
Goblet cells
granulomas
Rose thorn ulcers
Kantors string sign

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245
Q

What is kantors string sign?

A

Strictures in Crohn’s

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246
Q

Crypt abscesses, pseudopolyps, depletion of goblet cells are seen in?

A

UC

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247
Q

Motion sickness treatment?

A

Hyoscine
Cyclizine
Promethazine

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248
Q

What coronary artery supplies the AVN?

A

RCA

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249
Q

What is the mode of action of spironolactone?

A

Collecting ducts

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250
Q

Cisplatin can cause renal dysfunction via?

A

ATN from direct nephrotoxicity

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251
Q

Very low CSF glucose in meningitis with viral signs?

A

mumps

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252
Q

Treatment of pulmonary HTN with response to vasodilators (IV nitric oxide)?

A

CCB- nifidipine

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253
Q

What causes Graves Disease?

A

igG antibodies to TSH receptors

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254
Q

SBP diagnosis?

A

Neutrophils in fluid >250

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255
Q

Bergers disease is?

A

IgA nephropathy seen as visible haematuria following URTI and hypertension

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256
Q

Bergers disease poor prognosis>

A

HTN

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257
Q

Right sided murmurs loudest on?

A

Inspiration

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258
Q

Immune cells bind to which part of antibodies?

A

Fc region

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259
Q

Multiple cysts in the liver with travel to India?

A

Hydatid cysts

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260
Q

What causes hydatid cysts?

A

Echinococcus granulosus

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261
Q

Management of hydatid cysts?

A

Surgery ensuring not to rupture

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262
Q

Alcohol binge causes polyuria by?

A

ADH inhibition

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263
Q

Non caseating granulomas are seen in?

A

Crohn’s not UC

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264
Q

Avoid donepezil in?

A

Bradycardia

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265
Q

How to remember sensory of hand?

A

L hand make a 6
Thumb first finger C6
then middle C7
Ring and little C8

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266
Q

Plt transfusion carries higher risk of?

A

Bacterial infection

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267
Q

How does pellagra present?

A

Dermatitis
Diarrhoea
Dementia

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268
Q

What is pellegra?

A

Niacin deficiency

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269
Q

What is porphyria cutanea tarda?

A

Photosensitive rash
Blistering and skin fragility
Face and dorsum of hands

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270
Q

Meningitis with parkinsonian signs?

A

Japanese encephalitis

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271
Q

Cause of upbeat nystagmus?

A

Cerebellar vermis lesions

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272
Q

Cause of downbeat nystagmus?

A

Arnold-Chiari malformation

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273
Q

Phenytoin can cause?

A

Gynaecomastia

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274
Q

P450 inducers:

A

Smoking
Phenytoin
Carbamazepine
Rifampicin
St Johns Wort
Chronic alcohol

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275
Q

P450 inhibitors:

A

Ciprofloxacin
Erythromycin
Isoniazid
Amiodarone
-Azoles
SSRIs
Sodium valproate

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276
Q

What causes a +ve cyanide-nitroprusside test?

A

Cystinuria

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277
Q

What is cystinuria?

A

AR recurrent renal stones due to COLA defect

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278
Q

Live vaccines how long apart?

A

4 weeks

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279
Q

Subacute thyroiditis seen as?

A

Tender goitre
Hyperthroidism
Raised ESR
Reduced uptake techneticum scan

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280
Q

Essential tremor inhertiance?

A

AD

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281
Q

What can worsen absence seizures?

A

Carbemazepine

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282
Q

ethosuximide in breast feeding?

A

Avoid due to sedation

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283
Q

Lamotrigine and breast feeding?

A

Safe

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284
Q

A wave of JVP

A

Atrial contraction

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285
Q

Absent A wave in JVP?

A

AF

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286
Q

C wave of JVP?

A

Closure of tricuspid valve

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287
Q

V wave in JVP?

A

Passive filling of blood in atrium against closed tricuspid valve

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288
Q

x descent JVP?

A

Ventricular systole

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289
Q

Y descent?

A

Opening of tricuspid valve

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290
Q

Which BRCA gene is associated with prostate cancer?

A

BRCA2

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291
Q

SGLT-2 inhibitor’s example?

A

Goes Loo toilet

Empagliflozin
Glucose excretion

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292
Q

DDP4-i example?

A

P looks like a lip

Linagliptin

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293
Q

T2DM management?

A

Metformin or MR
+ SGLT2-inhibitor (CVD, QRISK >10)
+ DDP-4 inhibitor
+ SU/ Pioglitazone
- GLP-1 mimetic BMI >35 or insulin

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294
Q

Avoid what medications in HOCM?

A

Ramipril

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295
Q

Electrolyte disturbance in QTC prolongation?

A

Hypocalcaemia

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296
Q

Inferior MI can lead to?

A

AV block

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297
Q

What does insulin bind to?

A

Tyrosine kinase receptor in cell membrane

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298
Q

Mechanism of action of digoxin?

A

Inhibits Na/K ATPase pump

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299
Q

Gliclazide is a?

A

SU

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300
Q

Gliclazide a SU causes?

A

Weight gain
Hypoglycaemia
HypoNa

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301
Q

SGLT2 inhibitors e.g., gliflozins SE?

A

Euglycaemic ketosacidosis
UTIs
Forniers gangrene

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302
Q

Congenital toxoplasmosis is seen as?

A

Cerebral calcifications
Chorioretinitis

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303
Q

Bupropion for smoking cessation can cause GTCS by what mechanism?

A

Inhibition of norepinephrine-dopamine reuptake and antagonism of nicotinic ACh receptors

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304
Q

Winging of scapula in muscular dystrophy?

A

Facioscapulohumeral muscular dystrophy

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305
Q

Facioscapulohumeral muscular dystrophy inheritance?

A

AD

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306
Q

Diffuse systemic sclerosis most specific antibody?

A

Anti Scl-70

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307
Q

Antibodies for Idiopathic membranous glomerulonephritis?

A

anti-phospholipase A2 antibodies

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308
Q

History of anaphylaxis test?

A

RAST

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309
Q

Non arteritic anterior ischaemic optic neuropathy (NAION) seen as?

A

Swollen pale disc and blurred margins

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310
Q

Acyclovir mode of action?

A

Inhibits DNA polymerase

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311
Q

Test for Zollinger-Ellison syndrome?

A

Secretin stimulation test- causing increase in gastrin

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312
Q

What is valency?

A

Number of distinct serotypes a vaccine can protect against

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313
Q

When do you give ciprofloxacin prophylaxis for SBP?

A

Ascites protein < or equal 15

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314
Q

Porphyria Cutanea Tarda cause?

A

Uroporphyrinogen decarboxylase deficiency

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315
Q

Acute intermittent porphyria cause?

A

Porphobilinogen deaminase

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316
Q

What complications of haemochromatosis are reversible with treatment?

A

Cardiomyopathy and skin pigmentation

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317
Q

Hypertensive retinopathy stages 1-4?

A

1- narrowing
2- AV nipping
3- cotton-wool spots, haemorrhages
4- papilledema

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318
Q

Chemotherapy leading to hypoMg?

A

Cisplatin

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319
Q

DVLA advice post multiple TIAs?

A

No driving 3 months

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320
Q

Double duct sign?

A

Pancreatic head carcinoma

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321
Q

Treatment of visceral lesishmaniasis?

A

Sodium stibugluconate

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322
Q

Loud S2

A

Pulmonary HTN

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323
Q

Carcinoid test for diagnosis?

A

Urinary 5-HIAA

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324
Q

Where is the medial longitudinal fasciculus (affected in internuclear ophthalmoplegia)?

A

Paramedian area of midbrain and pons

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325
Q

Bisferiens pulse AKA double pulse seen in?

A

Mixed aortic valve disease, HOCM

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326
Q

Osteogenesis imperfecta is a abnormally synthesized collagen of which type?

A

1

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327
Q

Passing emboli with DVT to stroke heart defect?

A

ASD- most commonly patent foramen ovale

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328
Q

Temporal lobes contain the?

A

Wernickes area

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329
Q

Oxygen dissociation curve shift?

A

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

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330
Q

How to calculate NNT?

A

1-ARR

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331
Q

People with allergy to aspirin may react to which DMARD?

A

Sulfasalazine

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332
Q

Smoking in UC?

A

Protective

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333
Q

Treatment of methanol poisoning?

A

Fomepizole

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334
Q

Action of fomepizole (tx methanol poisoning)?

A

Competitive inhibition of alcohol dehydrogenase

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335
Q

Next step if angina not controlled by BB?

A

+ Amlodipine

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336
Q

Short PR interval?

A

Wolff-Parkinson White syndrome

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337
Q

Causes of prolonged PR interval?

A

IHD
Digoxin toxicity
HypoK
Rheumatic fever
Aortic root abscess
Lyme disease
Sarcoidosis
Myotonic dystrophy

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338
Q

Neisseria meningitides gram stain?

A

Gram negative cocci

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339
Q

MODY treatment?

A

SU
Gliclazide

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340
Q

Most common adult viral meningitis?

A

Cocksakie virus B

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341
Q

Brittle asthma with brown sputum and high eosinophils think?

A

Allergic bronchopulmonary aspergillosis

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342
Q

Drug induced cholestasis?

A

COCP

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343
Q

Prominent V waves on JVP?

A

Tricuspid regurgitation

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344
Q

What does the golgi add to proteins for trafficking to lysosomes?

A

Mannose-6-phosphate

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345
Q

G1 phase determines?

A

Cell length associated with p53

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346
Q

Histology of IgA nephropathy?

A

Mesangial hypercellularity
IgA
C3

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347
Q

SGLT2 works in the?

A

PCT

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348
Q

SU acts on the?

A

beta cells

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349
Q

Action of Anastrozole?

A

Aromatase inhibitor

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350
Q

Lofepramine is a?

A

TCA

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351
Q

Normovolaemic hypoNa drug causes?

A

TCA
Carbmazepine
SU
SSRIs

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352
Q

Thin blood film determines?

A

Speciation

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353
Q

Thick blood film determines?

A

parasite burden

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354
Q

What is a leukaemoid reaction?

A

Immature cells due to severe infection/ haemolysis/ haemorrhage

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355
Q

Dohle bodies in white cells?

A

Leukaemoid reaction
High Leukocyte ALP score

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356
Q

What is Lofgren’s syndrome?

A

Acute sarcoidosis:
- Erythema nodosum
- Bilateral hilar lymphadenopathy
- Polyarteritis

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357
Q

Treatment of pulmonary HTN?

A

+ve response vasodilators = CCB

-ve result to vasodilators =
iloprost
Sildenafil

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358
Q

How does NAC work?

A

Replenishes glutathione

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359
Q

Immunoglobulins in autoimmune hepatitis?

A

IgG

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360
Q

What is whipples disease?

A

tropheryma whipplei infection

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361
Q

PAS staining granules seen in?

A

Whipples disease

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362
Q

Pneumonia with cold sores?

A

Strep pnuemonia

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363
Q

Sickle cell long term crisis prevention?

A

Hydroxycarbamide

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364
Q

Acoustic neuromas seen as?

A

Dizziness
Hearing loss
Loss of corneal reflex as compresses trigeminal nerve

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365
Q

Medication induced tinnitus?

A

Quinine

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366
Q

Haloperidol blocks?

A

D2 antagonist

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367
Q

Cause of Erysipelas?

A

Strep pyogens

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368
Q

SLE complement low?

A

C4

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369
Q

Cant take triptans with?

A

SSRI due to increased risk of serotonin syndrome

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370
Q

QT interval and calcium?

A

Hyper - shorts
Hypo- prolongs

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371
Q

Ehlers-Danlos collagen affected?

A

Collagen type 3

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372
Q

Driving post ICD insertion?

A

1 week

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373
Q

Ann Arbour staging?

A

I- single LN region
II- 2+ regions on same side
III- nodes on both sides
IV- beyond lymph nodes

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374
Q

HIV and nephrotic syndrome?

A

FSGS

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375
Q

Poor shoulder external rotation?

A

Adhesive capsulitis

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376
Q

Bullous pemphegoid biopsy?

A

IgG and C3 at dermoepidermal junction

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377
Q

Strep sanguini/mitis IE check up?

A

Dental review

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378
Q

Strep gallotyticus IE cause?

A

Bovis
colorectal cancer

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379
Q

Reactive arthritis organism?

A

No organism in fluid
Chlamydia

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380
Q

Eczema herpeticum infection cause?

A

HSV 1 +2

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381
Q

IE <2 months post replacement?

A

Staph epidermidis

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382
Q

Most common cause of IE?

A

Staph aureus

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383
Q

Renin in renal artery stenosis and Conns?

A

Conns LOW
RAS HIGH

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384
Q

In MI due to cocaine also give?

A

IV lorazepam

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385
Q

Action of bisphosphonates?

A

Inhibits osteoclasts

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386
Q

Secretin is secreted from?

A

S cells in small intestine

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387
Q

Test for HIV when query of seroconversion illness?

A

p24 antigen test

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388
Q

Myoclonic seizures treatment in males?

A

Sodium valproate

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389
Q

Monoclonal antibody used to prevent recurrence of C. diff in high risk?

A

Bezlotoxumab

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390
Q

What is miller-Fisher variant?

A

GBS variant affecting CN first, often eyesight, and preceded by infection

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391
Q

Conversion disorder is?

A

FND loss of motor or sensory function

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392
Q

Thiazides act at the?

A

Proximal DCT

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393
Q

Damage to what area causes hemiballismus?

A

Subthalamic nucleus

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394
Q

Causes of pseudogout?

A

Haemachromatosis
Low Mg
Low PO42-
Acromegaly
Hyperparathyroidism

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395
Q

Early RA finding on x-ray?

A

Juxta-articular osteoporosis

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396
Q

What is the power of a study?

A

1 - the probability of a type II error (correctly rejecting the null hypothesis)

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397
Q

Causes of tunnel vision?

A

papilloedema
glaucoma
retinitis pigmentosa
choroidoretinitis
optic atrophy secondary to tabes dorsalis

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398
Q

Pleural effussion caused by hypothyroidism?

A

Transudative

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399
Q

Cherry red lung lesion?

A

carcinoid

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400
Q

First line for secretions in palliative care?

A

Hyoscine butlbromide

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401
Q

Typhoid rash?

A

Rose spots, salmon macules on trunk and abdomen

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402
Q

Typhoid fever can cause HR to?

A

Relative bradycardia

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403
Q

HIV and breastfeeding?

A

NO

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404
Q

Anti-RNP?

A

Mixed connective tissue disease

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405
Q

What activates macrophages?

A

Interferon-y

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406
Q

Most common SLE renal disease?

A

Diffuse proliferative glomerulonephritis

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407
Q

Restless leg syndrome blood test?

A

ferritin

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408
Q

Hunger controlled by which brain region?

A

Ventromedial area of hypothalamus

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409
Q

What is Fanconi syndrome?

A

Reabsorptive defect in PCT with excretion of amino acids, glucose, bicarbonate + phosphate

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410
Q

Haemophilia A inheritance?

A

X linked recessive

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411
Q

In X linked recessive conditions who cant transmit?

A

Male to male

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412
Q

What complement deficiency predisposes you to Neisseria meningitidis infection?

A

C5-9 deficiency

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413
Q

What is phase 1 drug metabolism?

A

Oxidation
Reduction
Hydrolysis

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414
Q

What is phase 2 drug metabolism?

A

Conjugation

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415
Q

What is cardiac syndrome X?

A

Microvascular angina with down sloping ST depression

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416
Q

Coeliac HLA?

A

HLA- DQ2

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417
Q

Causes of raised TLCO?

A

Asthma
Pulmonary haemorrhage
L-R cardiac shunts
Polycythaemia

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418
Q

Causes of lower TLCO?

A

Fibrosis
Pneumonia
PE
Oedema
Emphysema
Anaemia
Low cardiac output

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419
Q

What is KCO?

A

Transfer coefficient (corrected for lung volume)

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420
Q

Reduced TLCO but increased KCO?

A

Pneumonectomy
Scoliosis
NM weakness
Ankylosing spondylitis

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421
Q

Loud S2?

A

Hypertension

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422
Q

Soft S2?

A

AS

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423
Q

Fixed split S2?

A

ASD

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424
Q

Reversed split S2?

A

LBBB, severe AS

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425
Q

Skewed distributions?

A

Mean - Median - Mode

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426
Q

Uric acid stones are?

A

Radiolucent

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427
Q

IBS treatment?

A

Antispasmodic + laxative (not lactulose), loperamide

+ linaclotide laxative

+ amitriptyline

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428
Q

Test to look for mutations?

A

PCR

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429
Q

Cause of acute epiglottitis?

A

Haemophilus influenzae type B

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430
Q

Hereditary spherocytosis test?

A

EMA binding test

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431
Q

Most important HLA matching in renal transplant?

A

DR

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432
Q

Match for HLA for long term graft survival?

A

A

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433
Q

Primary hyperparathyroidism?

A

High or normal PTH
Hypercalcaemia

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434
Q

Secondary hyperparathyroidism?

A

High PTH in response to hypocalcaemia
Secondary to Vit D deficiency or renal failure

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435
Q

Tertiary hyperparathyroidism?

A

Prolonged secondary with high PTH and normal calcium

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436
Q

Management of drug induced parkinsons if medication cant be stopped?

A

Benzhexol/ trihexyphenidyl

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437
Q

Most common organism in bronchiectasis?

A

Haemophilus influenzae

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438
Q

Following bells palsy patients may complain of?

A

Hyperacusis (sensitivity to sound due to facial nerve innervating stapedius)

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439
Q

Does coal dust lead to lung cancer?

A

NO

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440
Q

SE of magnesium sulphate?

A

Respiratory depression
Reflexes
Oxygen saturations

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441
Q

Reversal of Mg sulphate respiratory depression?

A

Calcium gluconate

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442
Q

Normal pO2 but decreased oxygen saturations?

A

Methaemoglobinaemia

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443
Q

Mutation in p53 gene name?

A

Li-fraumeni syndrome

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444
Q

Inheritance of Li-Fraumeni syndrome?

A

AD

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445
Q

Cancers of Li-Fraumeni syndrome (p53 mutation)?

A

Breast cancer
Sarcoma
Leukaemia

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446
Q

Poor repetition aphasia?

A

Conduction dysphasia

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447
Q

What is expressive dysphagia?

A

Non fluent and halting

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448
Q

What is receptive dysphasia?

A

Fluid but incomprehensible

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449
Q

Hereditary spherocytosis crisis management?

A

IVF and high dose folic acid
Transfusion if symptomatic of anaemia

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450
Q

Tumour lysis syndrome treatment?

A

Rasburicase and IVF

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451
Q

Warm haemolytic anaemia can be caused by?

A

Non Hodgkin’s lymphoma
CLL

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452
Q

Psoriasis treatment?

A

Emollient
Topical steroid
Topical calcipotriol

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453
Q

PBC Ig raised?

A

IgM

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454
Q

Driving following unprovoked seizure with normal imaging?

A

6 months

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455
Q

Driving advice after seizure with imaging changes?

A

12 months

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456
Q

VSD murmur?

A

Holosytolic, harsh murmur

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457
Q

PDA murmur?

A

Continuous machinery murmur

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458
Q

Collapsing pulse?

A

MR
PDA

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459
Q

Digoxin toxicity ECG changes?

A

ST depression
Short QT
Inverted T
Prolonged PR

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460
Q

Hypokalaemia ECG?

A

Prolonged PR
Long QT
ST depression
U waves

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461
Q

Action of flecanide?

A

Blocks Na channels prolonging rapid depolarisation (phase 0)

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462
Q

How does amiodarone work?

A

Blocks voltage gated K channels, delaying repolarisation

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463
Q

Ablation for AF location?

A

Between pulmonary veins and L atrium

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464
Q

Ablation for atrial flutter location?

A

Cavotricuspid isthmus

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465
Q

Broad complex tachycardia ms?

A

> 120ms

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466
Q

Inherited causes of TdP?

A

Romano-Ward and Jervell
Lange- Nielson syndrome

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467
Q

Acquired causes of TdP?

A

TIMES

Toxins: clarithromycin, TCA, anti arrythmics, anti psychotics, SSRIs
Ischaemia
Myocarditis
Electrolytes: hypo K, Mg, Ca
SAH

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468
Q

Congenital TdP prevention?

A

BB

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469
Q

ECG osbourne waves?

A

Hypothermia

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470
Q

How to control BP in dissection?

A

IV metoprolol

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471
Q

What is Heydes syndrome?

A

Complication of AS with depletion of VWF-2a causing GI bleed and angiodysplasia with ID

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472
Q

Severe AS classification:

A

Peak gradient >40
Valve area <1
Jet velocity >4
Clinical absent S2

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473
Q

Medical management of HF?

A

ACEi + BB

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474
Q

When is surgical intervention needed for AS?

A

Symptomatic
LVEF <50
LVEF >50 but fall in BP on exercise testing
Severe pulmonary HTN >60

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475
Q

LVH on ECG?

A

P Mitrale

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476
Q

Mitral stenosis of hoarseness due to compression of recurent laryngeal nerve?

A

Ortner’s syndrome

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477
Q

What is Ebsteins anomaly?

A

R sided HF in young due to structurally abnormal tricuspid valve (TR)

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478
Q

Cause of rheumatic fever?

A

Group A beta haemolytic strep (scarlet fever)

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479
Q

Signs of rheumatic fever?

A

Arthritis
Sydenhams chorea
Erythema marginatum
SC nodules

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480
Q

Treatment of rheumatic fever?

A

STAT Benzylpenicillin
10 days phenoxymethylpenicillin

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481
Q

Most common valve problem in rheumatic fever?

A

MS

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482
Q

Becks triad and what for?

A

Cardiac tamponade

Hypotension
Quiet heart sounds
Raised JVP

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483
Q

Pulsus paradoxus?

A

Cardiac tamponade

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484
Q

Takotsubo cardiomyopathy?

A

Stress induced transient apical ballooning
ST elevation with trop rise but normal angiogram

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485
Q

ARVC?

A

AD fatty fibrous replacement of myocardium showing hypokinetic segment on R ventricle

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486
Q

Dilated cardiomyopathy HF?

A

HFrEF

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487
Q

Causes of dilated cardiomyopathy?

A

Toxins
Cocksakie B
Haemochromatosis
Amyloidosis
Sarcoidosis
Wet beri beri (thiamine def)

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488
Q

What causes hypertrophic cardiomyopathy?

A

AD mutation in sarcomeres leading to LVH

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489
Q

Diagnostic ECHO findings of hypertrophic cardiomyopathy?

A

MR SAM ASH

Mitral regurgitation
Systolic anterior motion of MV leaflets
Asymmetrical septal hypertrophy

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490
Q

Treatment of hypertrophic cardiomyopathy?

A

BB

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491
Q

Most common cause of ASD?

A

patent foramen ovale

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492
Q

EF for rEF?

A

<40%

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493
Q

Normal EF?

A

50-70%

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494
Q

Mortality benefit in HF?

A

BB
ACEi
Spironolactone
Hydralazine

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495
Q

HF medical management:

A

ACE-i (or ARB) + BB (or hydralazine) start one at a time

Symptoms persisting:
+ Spironolactone (eplerenone)
+ Ivabradine, digoxin, hydralazine

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496
Q

Angina treatment?

A

BB or verapamil
BB + amlodipine/ MR nifedipine
Or long acting nitrate, Ivabradine, Nicorandil

Secondary prevention: Statin 80, aspirin 75

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497
Q

Persistent ST elevation?

A

Left ventricular aneurysm

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498
Q

Management of Dresselers syndrome?

A

High dose aspirin

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499
Q

How is a cholesterol emboli seen?

A

Renal failure
Eosinophilia
Livedo rectularis

After cardiac catherization commonly

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500
Q

What is wellen syndrome?

A

Deeply inverted or biphasic T waves in V2-3 showing LAD stenosis

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501
Q

Incomplete BBB?

A

QRS 110-120ms

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502
Q

Most specific for pericarditis?

A

PR depression

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503
Q

P pulmonale is?

A

R atrial enlargement

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504
Q

Pulmonary HTN diagnosis?

A

R heart catherization with Mean PAP >25

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505
Q

What is brugada syndrome?

A

AD Na channelopathy seen with coved ST elevation of >2mm in >1 V1-3 followed by T wave inversion

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506
Q

Treatment of brugada syndrome?

A

ICD

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507
Q

Mechanism of action of digoxin?

A

Na/K ATPase inhibitor
Parasympathetic to SAN

(positively inotropic, negatives chronotropic)

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508
Q

ECG changes in digoxin toxicity?

A

Reverse Tick sign
Down sloping ST depression

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509
Q

Location of cardiac myxoma?

A

L atrium

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510
Q

Methadone overdose can cause cardiac arrest by?

A

QT prolongation

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511
Q

Action of loop diuretics (furosemide, bumetanide)?

A

Ascending loop and Henle

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512
Q

Avoid which medications in HOCM?

A

ACEi

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513
Q

Brugada mutation gene?

A

SCN5A gene

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514
Q

Prinzmetal angina management?

A

CCB felodipine

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515
Q

Egg on a string heart appearance?

A

Transposition of the great arteries

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516
Q

What causes transposition of the great arteries?

A

Failure of the aorticopulmonary septum to spiral

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517
Q

What is the mechanism of action of dipyridamole?

A

Phosphodiesterase inhibitor decreasing cellular uptake of adenosine

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518
Q

Antithrombotic to be started in bioprostehtic heart valves?

A

Aspirin

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519
Q

Antithrombotics to be started in mechanical heart valves?

A

Warfarin + aspirin

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520
Q

Poor prognosis in HOCM?

A

Septal wall thickness >3cm

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521
Q

Predicting response to cardiac resynchronisation therapy?

A

ECG - LBBB
TTE

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522
Q

Inherited long QTc and sensorineural deafness?

A

Jervell and Lange-Nielsen syndrome

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523
Q

Strongest risk factor for IE?

A

Previous IE

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524
Q

What is the mode of action of nicorandil?

A

K channel activator

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525
Q

After electrical cardioversion for AF how long should anticoag be continued for?

A

4 weeks

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526
Q

PET scans use?

A

Fluorodeoxyglucose

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527
Q

Check U+E before starting amiodarone to detect?

A

HypoK

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528
Q

ACEi cough due to increased?

A

Bradykinin

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529
Q

Valsalval maneourve causes?

A

reduced venous return

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530
Q

Good prognosis in IE?

A

Strep viridans

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531
Q

Why does long QT syndrome occur?

A

Blockage of K channels

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532
Q

Streptococcus viridans abx?

A

IV benpen

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533
Q

Treatment of prolactinoma?

A
  • Cabergoline
    (bromocriptine if pregnant)
  • If medical management fails = surgery
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534
Q

Cushing disease is a?

A

Pituitary adenoma

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535
Q

Diagnosis of cushings disease?

A

High dose dexamethasone suppression test

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536
Q

Diagnosis of cushings syndrome?

A

Low dose dexamethasone suppression test

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537
Q

Is cushing syndromes cortisol suppressed by low dose dexamethasone suppression test?

A

No

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538
Q

Cortisol and ACTH following high dose dexamethasone suppression test?

A

Cushing disease: low cortisol, low ACTH

Ectopic ACTH: high cortisol, high ACTH

Cushing syndrome: high cortisone, low ACTH

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539
Q

If surgery not an option for Cushing’s disease give?

A

Metyrapone

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540
Q

Screening for acromegaly?

A

IGF-1

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541
Q

Diagnosis of acromegaly?

A

OGTT

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542
Q

FU for acromegaly?

A

Colonoscopy
ECHO

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543
Q

Action of ADH?

A

upregulating aquaporin-2 channels to collecting ducts concentrating urine

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544
Q

Causes of SIADH?

A
  • Pituitary adenoma
  • SCLC production
  • Meningitis, CNS tumours, intracranial haemorrhage
  • SSRIs, tricyclics, carbamazepine
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545
Q

Emergency management of hypoNa?

A

150ml 3% NaCl bolus

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546
Q

SIADH managemet?

A

Correct cause
FR 750ml
If ineffective domeclocycline

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547
Q

Diabetes insipidius AKA arginine vasopressin disorder is?

A

Too little ADH

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548
Q

Diagnosis of Diabetes insipidus (arginine vasopressin disorder)?

A

Fluid deprivation test 8h
Synthetic ADH (desmopressin)

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549
Q

Adrenal hormones layers:

A

G Aldosterone
F Cortisol
R Androgens

Medulla adrenaline/ nor

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550
Q

Antibodies associated with Addisons?

A

adrenal cortex antibodies
21-hydroxylase antibodies

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551
Q

Diagnosis of addisons?

A

Short Synacthen test

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552
Q

Action of aldosterone?

A

Na reabsorption
K and H secretion
At DCT

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553
Q

Radioidone number?

A

I-131

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554
Q

Who cant have radioiodine?

A

Pregnant or breast feeding
Worsens thyroid eye disease

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555
Q

How long to wait to conceive after radioiodine?

A

Women 6 months
Man 4 months

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556
Q

Management of thyrotoxic storm?

A

Propylthiouracil
Propranolol
Steroids
Prednisolone
Cooling

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557
Q

Affect of amiodarone on thyroid?

A

Mostly hypothyroidism (AIH) via Wolff-Chiakoff effect
Can cause AIT thyrotoxicosis- stop

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558
Q

AIT type 1?

A

Goitre treat with carbimazole

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559
Q

AIT Type 2

A

Corticosteroids

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560
Q

Antibodies in hashimotos thyroiditis?

A

Anti TPO
Anti Thyroglobulin
Anti TSH receptor

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561
Q

What is De Quervains thyroiditis?

A

Self limiting painful goitre after URTI

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562
Q

Papillary adenocarcinoma of thyroid?

A

Thyroglobulin tumour maker
Orphan annie nuclei
Psommoma bodies

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563
Q

Follicular adenocarcinoma of thyroid?

A

Thyroglobulin tumour marker
Hurthle cell change (follic hurt)

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564
Q

Poor prognosis thyroid cancer?

A

Anaplastic/ undifferentiated

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565
Q

Medullary carcinoma of thyroid?

A

CEA and calcitonin markers
Electron dense granules

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566
Q

Rickets sign?

A

Cupping and splaying of metaphyses
Rosary sign

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567
Q

What is Phaeochromocytoma?

A

Adrenal medulla tumour (chromaffin cells) secreting catecholamines

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568
Q

3 genetic conditions linked to phaeochromocytoma?

A

MEN 2
NF 1
Von Hippel Lindau

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569
Q

Test for phaeochromocytoma?

A

24 hr urinary collection of metanephrines

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570
Q

Management of phaeochromocytoma?

A

Alpha blockade- phenoxybenzamine
Then propranolol

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571
Q

MEN 1:

A

3 P’s

Pituitary adenoma
Parathyroid hyperplasia
Pancreas

MEN1 gene AD

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572
Q

MEN 2a:

A

Parathyroid hyperplasia
Medullary carcinoma
Phaeochromocytoma

RET gene AD

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573
Q

MEN 2b:

A

Medullary carcinoma
Phaeochromocytoma
Mucosal neuromas
Marfanoid

RET gene AD

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574
Q

Which cancer can cause hyperparathyroidism?

A

Sqaumous cell lung ca with PTHrP

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575
Q

Which hormones can sqaumous cell lung cancer secrete?

A

PTHrP
b-HCG

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576
Q

Which lung cancer can cause SIADH and cushings?

A

Small cell lung cancer

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577
Q

MODY 3 mutation?

A

HNF1A

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578
Q

MODY 3 BM and management?

A

HIGH BM
SU

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579
Q

MODY 2 management?

A

Diet

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580
Q

Contraindications to metformin?

A

eGFR <30
Serum creat >150

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581
Q

Pioglitazone SE?

A

Water retention- not in HF
Bladder cancer

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582
Q

HHS definition?

A

BM 30+
Without ketones <3 or acidosis pH >7.3/bicarb >15

Osmolality 320+

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583
Q

How do you calculate osmolality?

A

2Na + glucose + urea

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584
Q

Response to HHS treatment?

A

Decrease in BM 5 an hour if not sliding scale

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585
Q

When does glucagon not work?

A

Starved/ cachectic
Alcohol

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586
Q

What are porphyrias?

A

Enzyme deficiencies in the haem synthesis pathway

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587
Q

Complication of porphyrias?

A

HCC

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588
Q

3 types of porphyria?

A

AIP- acute intermittent AD
PCT- Porphyria cutanea tarda
Variegate AD

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589
Q

Defect in AIP- acute intermittent porphyria?

A

Porphobilinogen deaminase
Urine red in light

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590
Q

PCT- porphyria cutanea tarda seen as?

A

pink urine under woods lamp
Photosensitive blistering rash

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591
Q

Defect in PCT, porphyria cutanea tarda?

A

Uroporphyrinogen decarboxylase

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592
Q

Variegate porphyria presentation?

A

Blistering photosensitive rash with abdo/ neuro involvement

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593
Q

Defect in variegate porpohyria?

A

Protoporphyrinogen oxidase

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594
Q

PCOS blood tests?

A

LH:FSH ratio >2
Normal FSH
SHBG low

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595
Q

Cause of impaired fasting glucose?

A

Hepatic insulin resistance

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596
Q

Causes of raised prolactin?

A

p’s:
pregnancy
prolactinoma
PCOS
primary hypothyroidism
phenothiazines, metoclopramide, domperidone

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597
Q

Small bilateral groin swellings?

A

Complete androgen insensitivity syndrome

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598
Q

Klienfelters gonadotrophin levels?

A

High

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599
Q

Secondary causes of hypercholesterolaemia not triglycerides?

A

Nephrotic syndrome
Cholestasis
Hypothyroidism

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600
Q

Fluid retention with pioglitazone increased if taken with?

A

Insulin

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601
Q

9am cortisol between 100-500nmol/l?

A

inconclusive and requires short synacthen test

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602
Q

What is Bartter’s syndrome?

A

defective NKCC2 channel in the ascending loop of Henle

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603
Q

What can reduce the absoprtion of levothyroxine?

A

Iron or calcium within 4 hours

604
Q

Hashimotos thyroiditis is linked to what cancer?

605
Q

Testosterone low?

A

Kallman syndrome

606
Q

What is the most common cause of primary hyperaldoesteronsim?

A

Bilateral idiopathic adrenal hyperplasia

607
Q

HLA antigens are on chromosome?

608
Q

Latex in what fruit?

609
Q

Hypopigmented lesions with reduced sensation?

609
Q

Antibody associated with breast Ca and ocular opsoclonus-myoclonus?

610
Q

What is the only licenced CCB in HTN?

A

Amlodipine

611
Q

Chlamydia treatment in pregnancy?

A

Erythromycin, azithromycin

612
Q

Bacterial vaginosis is caused by?

A

Gardnerella vaginalis

613
Q

Mechanism of action of cyclizine?

A

H1 receptor antagonist

614
Q

Mechanism of action of metoclopramide, domperidone/

A

D2 receptor antagonist

615
Q

Small intestine overgrowth test?

A

Hydrogen breath test

616
Q

Treatment for SI overgrowth?

617
Q

Increased risk of C. diff if taking?

618
Q

Cholera gram stain?

A

Gram neg common shaped, single flagellum

619
Q

Complications of coeliac disease?

A

Hypothyroidism
Malabsoprtion
Osteoporosis
Enteropathy associated T cell lymphoma (NHL)

620
Q

Whipples disease treatment?

A

2w IV ceftriaxone then 12-24 months Po co-trimoxazole

621
Q

Docusate sodium?

A

Stool softener

622
Q

Lactulose and macrogol?

623
Q

Senn, bisacodyl, sodium picosulfate?

624
Q

What is Plummer-Vinson syndrome?

A

Dysphagia with IDA due to upper esophageal web

625
Q

Investigation for achalasia?

A

Manometry (failure of lower sphincter to relax)

626
Q

Achalasia barium swallow?

A

Birds beak

627
Q

Why no OGD in pharyngeal pouch?

A

Risk of perforation

628
Q

Baretts can progress to?

A

oesophageal adenocarcinoma (colomnar epithelium)

629
Q

Low grade Barrets?

A

PPI review 6 months

630
Q

High grade Barrets?

631
Q

Triple therapy for H. pylori?

A

PPI
Clarithromycin
Amoxicillin (metro in pen allergy)

632
Q

H. pylori more increased risk of?

A

Duodenal ulcers

633
Q

What is Zollinger-Ellison syndrome?

A

Gastrinoma releasing excess gastrin

634
Q

Investigation for Zollinger-Ellison syndrome?

A

Secretin stimulation test

635
Q

Investigation for gastroparesis?

A

solid meal gastric scintigraphy

636
Q

4 Stages of hepatic encephalopathy?

A

1- Altered mood and behaviour
2- Drowsiness, confusion, personality change
3- Incoherency, asterixis
4- Coma

637
Q

Indications for liver transplant in paracetamol overdose?

A

pH <7.2 24h post ingestion

PT >100 + creat >300 + grade 3/4 encephalopathy

638
Q

Indications for liver transplant not due to paracetamol overdose?

A

PT >100

Any 3 of:
- drug induced liver failure
- age <10 or >40
- 1 week from jaundice to encephalopathy
- Bili 300+

639
Q

Dose over what for paracetamol overdose?

640
Q

NAC guidelines?

A

<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
Q

Type 1 autoimmune hepatitis?

A

Anti-SMA
ANA

642
Q

Type 2 autoimmune hepatitis?

A

Anti liver/ kidney microsomal antibodies type 1

643
Q

Type 3 autoimmune hepatitis?

A

Anti soluble liver-kidney antigen

644
Q

Anti-HBs positive all others negative?

A

Previous immunisation

645
Q

Anti-HBc positive, HBsAg negative?

A

Previous infection, not a carrier

646
Q

Anti-HBc positive, HbsAg positive?

A

Previous hep B now a carrier

647
Q

What type of virus is Hep A?

A

RNA piconavirus

648
Q

Transmission of Hep A?

A

Facecal-oral

649
Q

What type of virus is Hep B?

A

dsDNA virus

650
Q

Transmission of Hep B?

A

Bodily fluids
Vertical

651
Q

IgM in hepatitis?

652
Q

IgG in hepatitis?

653
Q

What type of virus is Hepatitis C?

A

RNA virus- flaviviridae

654
Q

Complications of Hep C?

A

Cirrhosis
HCC
PCT

655
Q

How is Hep C trasmitted?

A

Bodily fluids

656
Q

Investigation for Budd-Chiari syndrome?

A

Doppler USS

657
Q

Thiamine is vitamin?

658
Q

Indications for TIPPS?

A
  • Secondary prophylaxis for oesophageal varices bleeding
  • Refractory ascites
  • Portal HTN in Budd-Chiari syndrome
659
Q

Drugs causing cholestasis?

A

Steroids
Co-amoxiclav
Flucloxacillin
Nitrofurantoin

660
Q

Two disorders of conjugation?

A

Gilberts
Crigler-Narjar

661
Q

Gilbert syndrome seen as?

A

Intermittent jaundice at times of stress not needing treatment

662
Q

Gilbert syndrome if a deficiency of and mutation?

A

Gluconyltranferase enzyme
UGT1A1

663
Q

Crigler-Naajar seen as?

A

Pre hepatic jaundice needing liver transplant

664
Q

Crigler-Naajar defeciency?

A

Diphosphate glucuorsyltransferase

665
Q

Mutation in Wilsons?

A

ATP7B on Chr 13

666
Q

Diagnosis of wilsons disease?

A

Genetic analysis of ATP7B gene

667
Q

Bloods in wilsons disease?

A

Low serum caeruloplasmin
Free copper increased
Reduced total serum copper

668
Q

Management of wilsons?

A

Penicillamine (or trientine hydrochloride)

669
Q

Haemachromatosis investigation?

A

Transferrin saturation High
ferritin
Low TIBC

670
Q

Mutations in haemachromatosis?

671
Q

Treatment of haemachromatosis?

A

Venesection
T sat <50
Ferritin <50

Second line desferrioxamine

672
Q

Primary biliary cirrhosis is?

A

Autoimmune scarring and stricture of intrahepatic ducts linked to HCC

673
Q

Primary sclerosing cholangitis is?

A

Autoimmune scarring and stricture of intra and extra hepatic ducts linked to UC

674
Q

Signs of PSC on biopsy and imaging?

A

Beaded sign
Onion skin histology

675
Q

Complications of PSC?

A

Cholangiocarcinoma
Colorectal cancer

676
Q

Modified Glasgow Score for pancreatitis?

A

PaO2
Age >55
Neutrophils >15
Calcium <2
Renal function- Urea >16
Enzymes LDH >600
Albumin <32
Sugar >10

677
Q

Pancreatitis is associated with calcium being?

678
Q

Alpha-1 anti trypsin deficiency mutation?

A

SERPINA1 gene- PIZZ most severe

679
Q

What happens in alpha-1 antityrpsin?

A

Reduced protection agaisnt neutrophil elastase

680
Q

Liver biopsy of alpha-1 anti trypsin?

A

Periodic acid schiff positive globules

681
Q

Smoking is protective in?

682
Q

Truelove and Witts criteria of UC?

A
  • 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
Q

Pyoderma granenosum is seen as and associated with?

A

Ulcer with purple overhanging edge
IBD

684
Q

What is Hairy leucoplakia?

A

benign condition caused by EBV and suggestive of underlying HIV infection.

685
Q

Familial adenomatous polyposis gene?

686
Q

FAP is treated prophylactically with?

A

Proctocolectomy

687
Q

What is gardeners syndrome?

A

Variant of FAP with epidermal cysts, supernummery teeth, osteomas and thyroid tumours

688
Q

Genetics of Lynch syndrome (HNPCC)?

A

AD mismatch repair genes mutation

689
Q

Mode of action of SU gliclazide?

A

binds to ATP dependant K channels on beta cells

690
Q

In pregnancy what thyroid associated protein increases?

A

thyroid binding globulin

691
Q

Hormones in Klienfelters syndrome?

A

high LH and low testosterone

692
Q

Elderly person with Diarrhoea + hypokalaemia

A

villous adenoma

693
Q

Gastrin acts on?

A

Gastric parietal cells

694
Q

PBC increased risk of HCC?

695
Q

What electrolyte in refeeding syndrome causes muscular weakness?

A

HypoPhosphataemia

696
Q

Most gastrinomas are found in the?

A

first part of the duodenum

697
Q

Bile acid malabsorption following IBD resection?

A

cholestyramine

698
Q

Hypoglycaemia and jaundice in pregnancy?

A

Acute fatty liver of pregnancy

699
Q

Lynch syndrome increases the risk of what 2 cancers?

A

Colorectal
Endometrial

700
Q

Primary biliary cholangitis - the M rule?

A

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

701
Q

What affects the Urea breath test?

A

Abx 4 weeks
PPIs 2 weeks

702
Q

Goblet cell depletion?

703
Q

cholangitis investigation?

704
Q

Hepatorenal syndrome type 1?

A

Rapid onset <2 weeks can be triggered by UGIB

705
Q

Hepatorenal syndrome type 2?

A

Gradual onset associated with refractory ascites

706
Q

CCK (bile acids) are secreted from?

A

I cells in upper small intestine

707
Q

Clindamycin SE?

A

Diarrhoea, high risk for C. diff

708
Q

Liver cirrhosis biopsy shows?

A

excess collagen and extracellular matrix deposition leading to formation of regenerative nodules

709
Q

Liver biopsy of alcoholic steatohepatitis?

A

Macrovesicular fatty changes with giant mitochondria, spotty necrosis and fibrosis

710
Q

What is a VIPoma?

A

neuroendocrine tumour from the non-beta islet cells of the pancreas secreting vasoactive intestinal peptide

711
Q

Drugs causing dyspepsia?

A

Steroids
NSAIDs
Bisphosphonates
- relax LOS
calcium channel blockers
nitrates
theophyllines

712
Q

What can cause decompensation in cirrhosis?

A

Constipation
Infection
Electrolyte imbalance
dehydration
Increased alcohol
UGIB

713
Q

Vaccines in coeliacs disease?

A

Pneumococcal every 5 years due to hyposplenism
Yearly influenza

714
Q

Non responders to Hep B vaccination should be tested for?

715
Q

Immunological subtypes and alcoholic liver disease?

716
Q

Immunological subtypes and PBC?

717
Q

Immunological subtypes and autoimmune hepatitis?

718
Q

What is Dubin-Johnson syndrome?

A

Benign AR with defective conjugated hepatic bilirubin excretion

719
Q

Defect in Dubin-Johnson syndrome?

A

cMOAT protein

720
Q

Drugs that cause pancreatitis?

A

azathioprine
mesalazine
didanosine
bendroflumethiazide
furosemide
pentamidine
steroids
sodium valproate

721
Q

What calcium can cause pancreatitis?

A

hypercalcaemia

722
Q

What can Hyperchylomicronaemia cause?

A

Pancreatitis

723
Q

Causes of pancreatitis?

A

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
Q

SAAG >11?

A

Portal HTN
- Cirrhosis
- HF
- Budd-Chiari

725
Q

SAAG <11?

A

Cancer
TB
Pancreatitis

726
Q

Pruritic rash on the buttocks or soles?

A

Strongyloides stercoralis

727
Q

Mode of action of oseltamivir?

A

Neuramindase inhibitor

728
Q

Mode of action of acyclovir?

A

Inhibits DNA polymerase

729
Q

Mode of action of remdesivir?

A

Inhbits RNA polymerase

730
Q

Grey coating of tonsils?

A

Diphtheria

731
Q

Cause of Diphtheria?

A

Corynebacterium diphtheriae

732
Q

Bilateral perihilar shadowing in HIV?

A

Pneumocystis jirovecii

733
Q

Management of Pneumocystis jirovecii with exertional sats drop?

A

Oral co-trimoxazole +/- steroids (if sats drop)

734
Q

Fish tank granuloma?

A

Mycobacterium marinum

735
Q

Parovirus B19 in pregnancy?

A

Risk of fetal hydrops- fetal transfusion

736
Q

LTRI in cardiomyopathies and alcoholics, with upper lobar involvement?

A

Klebsiella

737
Q

Tuberculoid leprosy seen by?

A

limited number of skin lesions, hypaesthesia and hair loss

738
Q

Lepromatous leprosy seen by?

A

Widespread involvement skin nodules
Leonine facies (thickened forehead, loss of eyebrows and eyelashes).

739
Q

Treatment of cutaneous larva migrans?

A

Thiabendazole

740
Q

Treatment of leprosy?

741
Q

Signs of CNS cryptococcal infection

A

HIV
Neuro symptoms
Lymphocytes
High opening pressure
High protein
Normal glucose

742
Q

Investigation for CNS cryptococcal infection?

A

India ink staining

743
Q

Clostridium is a?

A

Gram-positive rod

744
Q

Treatment of latent syphilis?

A

benzathine penicillin IM

745
Q

Black painless eschar seen in?

746
Q

Treatment of anthrax?

A

ciprofloxacin

747
Q

African sleeping sickness is?

A

trypanosomiasis (African sleeping sickness)

748
Q

Lassa virus from?

749
Q

Brucella diagnosis from unpastrurised milks?

750
Q

Toxoplasmosis and immunocompetent?

A

Supportive treatment

751
Q

Toxoplasmosis and immunocompromised?

A

Pyrimethamine + sulphadiazone

752
Q

Chronic Hep C test?

A

anti-HCV antibody test

753
Q

In syphilis regardless of treatment what stays positiev?

A

Treponema pallidum haemagglutination test (TPHA)

754
Q

Yellow fever presentation?

A

Jaundice and UGIB

755
Q

Tetanus is the inhibition of?

756
Q

Kaposi’s sarcoma is caused by what virus?

A

HHV-8 (human herpes virus 8)

757
Q

Action of Rifampicin

A

inhibits RNA synthesis

758
Q

peripheral blood smear showing red blood cell agglutination which pneumonia causing bacteria, and erythema multiforme (target lesions)?

A

Mycoplasma pneumoniae

759
Q

Mechanism of action of tetracyclines?

A

inhibit the 30S subunit of ribosomes

760
Q

American trypanosomiasis?

A

Chagas disease/ cruzi

761
Q

How is chagas disease presented?

A

Periorbital oedema
Dilated cardiomyopathy

762
Q

Treatment of chagas disease?

A

Benzdazole

763
Q

Egg proteins seen in which vaccine?

A

Yellow fever

764
Q

Triad of Disseminated gonococcal infection?

A

Dermatitis
Migratory polyarthritis
Tenosynovitis

765
Q

False negatives on tuberculin test occur due to?

A

immunodeficiency
e.g., HIV, lymphoma, sarcoidosis

766
Q

Treat campylobacter with?

A

Clarithromycin

767
Q

Shigella abx?

A

Ciprofloxacin

768
Q

In HIV treatment Integrase inhibitors (‘gravirs’) have what mode of action?

A

blocks the enzyme that inserts the viral genome into the DNA of the host cell

769
Q

EBV is associated with which 3 malignancies?

A

Burkitt’s lymphoma
Hodgkin’s lymphoma
nasopharyngeal carcinoma

770
Q

Rickettsia ricketsii is?

A

Rocky Mountain Spotted Fever

771
Q

Surgical third nerve palsy?

A

Pupil involved- posterior communicating artery aneurysm

772
Q

How is conus medularis syndrome seen?

A

cauda equina with hyperreflexia

773
Q

Charcot marie tooth syndrome seen as?

A

Sensory and motor neuropathy
Pes cavus
Muscle wasting
Thickening of nerves

774
Q

Charcot marie tooth inheritance?

775
Q

Motor region in the?

A

Frontal lobe

776
Q

Sensory area in the?

777
Q

Empty delta sign?

A

Intracranial venous thrombosis

778
Q

What is the mode of action of mannitol?

A

Osmotic diuretic on PCT and loop of henle

779
Q

How is cerebellar syndrome seen?

A

DANISH

Dysdiadochokinesia
Ataxia
Nystagmus (downbeat)
Intention tremor
Slurred speech
Hypotonia

780
Q

How is Freidrichs ataxia seen?

A

Teens with upper and lower MN lesions, high arched palate, cerebellar signs

781
Q

Hereditary spastic paraparesis seen as?

A

Lower limb spasticity and hyperreflexia

782
Q

MND is due to?

A

misfolding of the TDP-43 protein

783
Q

Duchennes and Becks dystrophy?

A

X linked recessive

784
Q

Myotonic Dystrophy inheritance?

785
Q

Presentation of myotonic dystrophy?

A

frontal balding
early cataracts
percussion myotonia (difficult to release handshake)
dysarthria
first degree heart block

786
Q

Antibodies associated with myasthenia gravis?

A

ACh-R antibodies, MuSK antibodies, LRP4 antibodies

787
Q

Drugs exacerbating myasthenia gravis?

A

BB, lithium, penicillamine, gentamicin, quinolones, phenytoin

788
Q

Management of myasthenia gravis?

A

pyridostigmine or neostigmine

789
Q

Management of myasthenia crisis?

A

IV immunoglobulins and plasma exchange.

Intubation and ventilation if FVC 15ml/kg or less

790
Q

Mechanism of action of baclofen

A

GABA analogue and selective agonists at GABA-b receptors, lipophilic

791
Q

HSV-1 encephalitits?

A

temporal lobes

792
Q

Anti-NMDA receptor encephalitis associated with?

A

Ovarian teratoma

793
Q

Triad of wernickes encephalopathy?

A

ataxia, confusion and ocular abnormalities (gaze evoked upbeat nystagmus)

794
Q

Acanthamoeba Meningitis is associated with?

A

Contact lens infection

795
Q

In CSF high protein and low glucose both in?

A

Bacterial and TB

796
Q

Ischaemic penumbra is the?

A

Area of ischaemia without necrosis in stroke

797
Q

Patent foramen ovale test (Stroke and DVT)?

A

Bubble ECHO

798
Q

Absent seizures?

A

Ethosuximide (unless pregnant/ breastfeeding)

799
Q

Driving and epilepsy?

A

1 seizure 6 months
1+ 1 year
Professional 1 5 years
Professional 1+ 10 years

800
Q

Miller fisher variant antibodies?

A

Anti-GQ1B antibodies

801
Q

When to intubate in GBS?

A

FVC <20ml/kg

802
Q

LP in GBS?

A

Isolated protein rise
Albumincytological dissociation

803
Q

Foot drop is caused by?

A

Common perineal nerve injury

804
Q

What is meralgia parethetica?

A

Compression of lateral cutaneous nerve seen with pains on outer aspect of thigh

805
Q

Weakness following exercise/ fasting/ infection with myoglobinuria?

A

Carnitine plamitoyl transferase deficiency

806
Q

Diagnosis of Carnitine plamitoyl transferase deficiency?

A

Muscle biopsy

807
Q

Unexplained syncope and dribing?

A

No driving 6 months

808
Q

Prophylaxis for cluster headaches?

809
Q

Antibodies and mechanism of action in lambert eaton myasthenic syndrome?

A

Anti VGCC against calcium channels

810
Q

Lambert eaton is associated with which cancer?

811
Q

Treatment of lambert eaton syndrome?

A

Amifampridine

812
Q

What is Paraneoplastic Encephalomyelitis?

A

Autoimmune encephalitis linked to SCLC with labile emotions and memory impairment

813
Q

What is MELAS?

A

Mitochondrial encephalopathy, lactic acidosis, stroke like episodes

814
Q

Muscle biopsy of MELAS?

A

Ragged red fibres

815
Q

What is Devics disease also called?

A

Neuromyelitis optica (NMO)

816
Q

How is NMO seen?

A

Peripheral and central demyelination
- optic neuritis
- Transverse myelitits (weakness, paralysis, sensory disturbance)
- Aquaporin 4 antibodies

817
Q

Causes of drug induced parkinsonism?

A

Haloperidol
Risperidone
Metoclopramide

818
Q

Cause of parkinsons disease?

A

Lewy body formation- intracellular inclusions of misfolded alpha synuclein

819
Q

Difference between lewy body dementia and parkinsons dementia?

A

Lewy body dementia- memory loss before or at the same time
Parkinsons disease dementia- years after motor symptoms

820
Q

Cause of progressive supranuclear palsy?

A

Tau deposition, often atremulous

821
Q

Cause of multi system atrophy?

A

Alpha synuclein deposition

822
Q

How is corticobasal degeneration seen?

A

Apraxia and aphasia
Alein hand syndrome

823
Q

Cause of corticobasal degeneration?

A

Intracellular tangles of misfolded tau proteins

824
Q

Symptomatic control of reversible cerebral vasoconstriction syndrome?

A

Nimodipine

825
Q

Medications leading to serotonin syndrome?

A

SSRIs, MDMA, ecstasy, MAOI, amphetamines, fentanyl, sumatriptan, ondansetron

826
Q

Acute labyrinthitis?

A

Vertigo and hearing loss/ tinnitus

827
Q

Vestibular neuritis?

A

Vertigo but hearing intact

828
Q

Nutrition support in MND?

829
Q

Conduction aphasia?

A

Cant repeat

830
Q

Diplopia with parkinsonism?

A

Progressive supranuclear palsy

831
Q

Ataxic telangiectasia: cerebellar ataxia and telangiectasia, onset is in childhood gene?

832
Q

Query SAH but no signs on CT within 6 hours of onset of symptoms?

A

Consider other diagnosis

833
Q

Bitemporal hemianopia- optic chiasm compression upper or lower?

A

Upper quadrant defect = inferior chiasmal compression, commonly a pituitary tumour
Lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

834
Q

Haemochromatosis doesnt really affect the?

835
Q

How is Juvenile myoclonic epilepsy seen?

A

seizures in the morning/following sleep deprivation

836
Q

Ondansetron works of the chemoreceptor trigger zone in the?

A

Medulla oblongata

837
Q

Sensory neuropathies include?

A

diabetes
uraemia
leprosy
alcoholism
vitamin B12 deficiency
amyloidosis

838
Q

Causes of HTN in NF-1?

A

phaechromocytoma (check catelcholamines)
renal vascular stenosis secondary to fibromuscular dysplasia

839
Q

Cluster headache acute management?

A

100% oxygen, SC sumatriptan

840
Q

Side effect of Natalizumab?

A

reactivation of the JC virus causing progressive multifocal leukoencephalopathy (PML)

841
Q

Tuberous sclerosis is seen with?

A

depigmented ‘ash-leaf’ spots
Shagreen patches
angiofibromas
subungual fibromata
cafe-au-lait spots

842
Q

Risk of what in nephrotic syndrome?

A

VTE due to loss of antithrombin III

843
Q

How is renal vein thrombosis seen?

A

Commonly with nephrotic syndrome
Loin pain
Haematuria

844
Q

Treatment of renal vein thrombosis?

845
Q

What is beurgers disease?

A

IgA nephropathy

846
Q

What is IgA nephropathy?

A

Nephritic syndrome 1-2 days after URTI

847
Q

What is post strep glomerulonephritis?

A

1-3 weeks post strep nephritic syndrome

848
Q

What kind of strep causes post strep glomerulonephritis?

A

Group A B haemolytic strep

849
Q

Biopsy of post strep glomerulonephritis?

A

Subepithelial bumps

850
Q

Tests high in post strep glomerulonephritis?

A

DNase
ASOT

851
Q

What is good pastures syndrome?

A

Anti GBM with pulmonary haemorrhage and AKI

852
Q

Biopsy of good pastures syndrome?

A

IgG standing on basement membranes
Necrotising crescents

853
Q

How is alport syndrome seen?

A

X linked dominant condition with:
Hearing loss
Optic issues
Haematuria

854
Q

What is the defect and biopsy findings of Alport syndrome?

A

Defect in collagen IV
Splitting of lamina densa and basket weave

855
Q

cup and spill/ egg in a cup?

A

Renal papillary necrosis

856
Q

What is acute interstitial nephritis?

A

Acute hypersensitivity reaction with rash, eosinophilia and fever

857
Q

Common drug causes of AIN?

A

Allopurinol
Abx
NSAIDs
Diuretics
PPIs

858
Q

Causes of membranoproliferative glomerulonephritis?

A

Hep C
Cryoglobulinaemia
Monoclonal gamminopathy

859
Q

Biopsy finding of membranoproliferative glomerulonephritis?

A

Double contour basement membrane

860
Q

Wergner’s (GPA) has?

861
Q

cANCA is?

862
Q

Wergners is seen with?

A

Sinusitis, epistaxis, pulmonary haemorrhage

863
Q

Churg strauss (EGPA) has?

864
Q

pANCA is?

A

MPO from monocytes

865
Q

churg strauss is seen as?

A

Allergic asthma, nasal polyps, esoinophilia

866
Q

Renal anaemia only expected with eGFR?

867
Q

Hb target in CKD?

868
Q

EPO only when?

A

Ferritin >100 (200 haemodialysis)
Tsat >20

869
Q

Kimmelsteil-wilson nodules are seen in?

A

Diabetic nephropathy

870
Q

Complication of long term dialysis leadign to CTS?

A

Beta 2 microglobulin amyloidosis

871
Q

CMV activation post renal transplant time frame?

872
Q

Treatment of CMV reactivation?

A

Gangcilovir

873
Q

Acute rejection of kidney transplant?

A

Within 6 months T cell mediated

874
Q

PKD1 chromosome?

875
Q

PKD2 chromosome?

876
Q

Treatment of PKD?

877
Q

Apple green birefriegence on congo red stain?

A

Amyloidosis

878
Q

Fusidic acid, clarithromycin, statins, colchicine increases risk of?

A

Rhabdomyolysis

879
Q

Struvite stones assoicated with?

A

Staghorn calculus and proteus infection

880
Q

Epithelial casts in urine?

881
Q

fatty casts in urine?

A

Nephrotic syndrome

882
Q

Bladder cancer associated with schistosomiasis and LTC >10 years?

883
Q

RTA type 1?

A

Distal
Unable to excrete H+ DCT/CD

884
Q

RTA type 2?

A

Proximal
Unable to reabsorb HCO3- in PCT

885
Q

RTA type 4?

A

HyperKa
Low aldosterone

886
Q

What can cause a false negative PSA (reducing it)?

A

Finasteride

887
Q

What are intensely painful, purpuric patches with an area of black necrotic tissue seen on the legs in ESRD with poor attendance?

A

Calciphylaxis lesion

888
Q

How do you differentiate from prerenal uraemia and ATN?

A

Urinary Na
High ATN
Low Prerenal uraemia

889
Q

If starting goserelin co-prescribe what for the first 3w?

A

cyproterone acetate - risk of tumour flare

890
Q

What is cyproterone acetate?

A

Anti-androgen treatment start at same time as goserelin

891
Q

What drug in post renal transplant gives you a tremor?

A

Tacrolimus

892
Q

Site of action of spironolactone?

A

cortical collecting ducts

893
Q

Lithium causes which type of DI?

A

Nephrogenic

894
Q

How do you calculate anion gap?

A

(Na+ + K+) - (Cl- + HCO-3)

895
Q

What is a normal anion gap?

896
Q

How long for arteriovenous fistula to develop so it can be used?

897
Q

RAS investigation?

A

MR angiogram

898
Q

Which renal disorder is associated with malignancy?

A

Membranous glomerulonephritis

899
Q

Atypical HUS is?

A

HUS without diarrhoea/ abdo pain/ E. coli

900
Q

Type 2 membranoproliferative glomerulonephritis is seen as?

A

Lipodystrophy with low C3

901
Q

Biopsy of FSGS?

A

Podocyte proliferation and collapse of basement membrane

902
Q

Treatment of epididymal orchitis?

A

IM ceftriaxone stat + oral doxycycline for 2 weeks

903
Q

High phosphate in CKD due to?

A

Reduced excretion

904
Q

Heroin use is linked to which renal disease?

A

focal segmental glomerulosclerosis

905
Q

Granulomatosis with Polyangiitis (GPA) linked to which renal disease?

A

Rapidly progressive glomerulonephritis

906
Q

Mechanism of action of Tolvaptan?

A

vasopressin receptor 2 antagonist

907
Q

Mechanism of action of Bicalutamide for prostate Ca?

A

androgen receptor blocker

908
Q

SLE linked to which renal disorder?

A

diffuse proliferative glomerulonephritis

909
Q

Restrictive spirometry?

A

> 0.7
In MND, myasthenia, ILD

910
Q

Obstructive spirometry?

A

<0.7
FEV1 reduced
Asthma, COPD

911
Q

If ? asthma with eosinophilia worsened by steroids consider?

A

Strongyloides

912
Q

Moderate acute asthma?

913
Q

Severe acute asthma?

A

33-50%
HR >110
RR >25
Cant complete sentences

914
Q

Life threatening acute asthma?

A

<33%
Sats <92%
Silent chest
Tiring
PaO2 <8

915
Q

Near fatal acute asthma?

A

Raised paCO2
Mechanical ventilation with increasing inflation pressures

916
Q

Ipratropium bromide mechanism of action?

A

SAMA
Antagonises acetlycholine

917
Q

Indications for lung reduction therapy in COPD?

A
  • Upper lobe predominant emphysema
  • FEV1 >20% predicted
  • PaCO2 <7.3
  • TLCO >20% predicted
918
Q

Criteria for LTOT?

A

PaO2 <7.3 on 2 occassions 3 weeks apart
PaO2 <8 + cor pulmonale, polycythaemia, pulmonary HTN

919
Q

How long should you use LTOT?

A

Atleast 15 hours a day

920
Q

Investigation for bronchiectasis?

A

High resolution CT showing:
Tram lines
Ring shadows
Signet ring

921
Q

When give prophylaxis in broncheictasis?

A

> 3 exacerbations a year

922
Q

Pseudomonas aeruginosa treatment?

A

Po cipro
IV tazocin
Nebulised colomycin

923
Q

What is allergic bronchopulmonary aspergillosis?

A

High IgE against aspergillus fumigatus. Treat with steroids and antifungals

924
Q

What is bronchiolitis obliterans?

A

Obstructive destruction by granulation tissue seen in RA or post lung transplant

925
Q

How do you treat bronchiolitis obliterans?

A

immunosuppression

926
Q

High resolution CT findings of ILD?

A

Honey combing
Ground glass

927
Q

If broncholavage in ILD >50% lymphocytes?

A

Add immunosuppression

928
Q

Upper interstitial lung disease causes?

A

HART

Hypersensitivity pneumonitis
Ankylosing spondylitis
Radiotherapy
TB

929
Q

Causes of lower lung fibrosis in ILD?

A

RAIDS

RA
Asbestosis
Idiopathic
Drugs
Sarcoidosis

930
Q

What drugs cause ILD lower fibrosis?

A

Methotrexate
Bleomycin
Amiodarone
Nitrofurantoin

931
Q

Treatment of idiopathic pulmonary fibrosis (lower zone)?

A

Pirfenidone
Nintedanib

932
Q

Mechanism of action of Pirfenidone for idiopathic ILD?

A

Decreases fibroblast

933
Q

Mechanism of action of nintedanib for idiopathic ILD?

934
Q

Cystic fibrosis mutation and chromosome?

935
Q

CF most common variant?

A

Delta- F508

936
Q

Contraindications to lung transplant?

A
  • 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
Q

Signs of massive PE needing thrombolysis?

A

Hypotension <90 for >15 mins
Cyanosis
R heart train (raised JVP, loud P2 and parasternal heave)

938
Q

Redcurrant sputum?

A

Klebsiella

939
Q

Mycoplasma pneumonia associated with?

A

Cold AIHA
Target lesions or erythema multiforme

940
Q

Exudative pleural effussion?

A

Protein >35

941
Q

What is a chylothorax?

A

Lymph fluid with high cholesterol after trauma

942
Q

What is meig syndrome?

A

Ovarian tumour
Ascites
Pleural effussion

943
Q

Catamenial pneumonthorax?

A

Secondary to endometrosis

944
Q

Pneumothorax not responding after 48h?

945
Q

How long til you can fly post radiological resolution of pneumothorax?

946
Q

What biologic can reactive TB?

A

Inflixamab

947
Q

Rifampicin SE?

A

Red coloured bodily fluids

948
Q

OHS seen as?

A

Chronic respiratory acidosis

949
Q

CD4 count for PCP?

950
Q

Signs of PCP?

A

Peri hilar
Crushed ping pong ball sign

951
Q

Treatment of PCP?

A

IV co-trimoxazole + steroids

952
Q

PiMZ in alpha-1-anti trypsin deficiency?

A

carrier and unlikely to develop emphysema if a non-smoker

953
Q

Normal genotype not alpha-1 anti trypsin?

954
Q

Alpha 1 anti tyrpsin deficiency meaning of genotype?

A

S- slow enzymes 50% normal
Z- very slow enzymes 10% normal

955
Q

First line investigation for asthma?

A

measure the eosinophil count OR fractional nitric oxide

956
Q

Look at upper airway compression best with?

A

Flow volume loop

957
Q

Good prognostic factors in sarcoidosis?

A

HLA B8

Lofgren’s syndrome (bilateral hilar lymphadenopathy, erythema nodosum, polyarthritis and fever)

958
Q

Stages of COPD?

A

1- mild >80
2- moderate >50
3- severe >30
4- very severe <30

959
Q

Most common cause of IECOPD?

A

Haemophilus influenzae

960
Q

Pleural plaques and FU?

961
Q

how many % of patients diagnosed with lung ca have a normal CXR?

962
Q

varenicline used in smoking cessation linked to?

A

suicidal behaviour

963
Q

Farmers lung is?

A

Saccharopolyspora rectivirgula

964
Q

Recommended settings for NIV for COPD?

A

EPAP: 5 cm H2O
IPAP: 10 cm H20 whilst BTS suggest 12-15 cm H2O
back up rate: 15 breaths/min

965
Q

Most people with sarcoidosis get better with?

A

without treatment

966
Q

CXR sarcoidosis stages?

A

1 = BHL
2 = BHL + infiltrates
3 = infiltrates
4 = fibrosis

967
Q

High risk characterisitics of pneumothorax needing chest drain?

A

Haemodynamic compromise
Significant hypoxia
Bilateral pneumothorax
Underlying lung disease
≥ 50 years of age with significant smoking history
Haemothorax

968
Q

HLA of RA?

A

HLA DR4
HLA DR1

969
Q

Most specific antibody for RA?

970
Q

Bets prognosis in RA?

A

RF negative

971
Q

Poor prognosis in RA?

A

Male
Early development
Erosions
RF
Anti CCP

972
Q

What is felty syndrome?

A

RA
Neutropenia
Splenomegaly

973
Q

What is caplan syndrome?

A

RA nodules
Coal workers lung

974
Q

DAs-28 in remission?

975
Q

Management stages of RA?

A
  1. methotrexate
    • sulfasalazine/ leflunomide
  3. DAS 28 >5.2 methotrexate + anti TNF
  4. Methotrexate + rituximab
976
Q

Examples of anti TNF?

A

Adalimumab
Infliximab

977
Q

Starting rituximab check?

978
Q

Starting methotrexate screen?

A

CXR
HBV, HCV

979
Q

Give what with methotrexate?

A

Folic acid OW

980
Q

What not to take or do on methotrexate?

A

X pregnancy 3 months
X progaunil, trimethoprim

981
Q

SE of sulfasalazine?

A

Decreases sperm count
Flare of G6PD
Agranulocytosis

982
Q

Pencil in the cup?

A

Psoriatic arthritis

983
Q

What DMARD not to give in psoriatic arthritis?

A

Hydroxychloroquine, exacerbates skin

984
Q

What is keratoderma blenorrhagica?

A

Dark maculopapular rash on palms and soles seen in reactive arthritis

985
Q

Most common cause of septic arthritis?

A

Staph aureus

986
Q

Most common cause of septic arthritis following replacement?

A

Staph epidermis

987
Q

Stills disease?

A

High temp
Salmon pink rash
High ferritin >1500
Leucocytosis and neutrophilia

988
Q

Treatment of still disease?

A

NSAID + aspirin

989
Q

Gout can be caused by which renal issue?

A

Lesch nyhan syndrome

990
Q

GCA USS?

991
Q

Biopsy of GCA?

A

Multinucleated giant cells

992
Q

Management of GCS?

A

Aspirin + high dose pred
Any visual symptoms pulsed IV methylprednisolone

993
Q

Polymyositis antibody?

994
Q

Muscle biopsy of polymyositis?

A

Endomysial infiltrates

995
Q

Muscle biopsy of dermatomyositis?

A

Perivascular infiltrates

996
Q

Antiphospholipid diagnosis?

A

2 tests 12 weeks apart

997
Q

Management of antiphospholipid syndrome?

A

Aspirin + warfarin

998
Q

SLE hypersentivity reaction?

999
Q

What is low in SLE?

1000
Q

Most common antibody in SLE?

1001
Q

Most specific antibody?

A

Anti smith (SnRNP)
Anti dsDNA

1002
Q

Drug induced lupus antibody?

A

Anti histone

1003
Q

Subacut cutaneous lupus antibody?

A

ANA
Anti-SS-A
Anti-SS-B

1004
Q

Treatment of SLE?

A

NSAID + hydroxycloroquine

1005
Q

Sjrogens hypersensitivity reaction?

1006
Q

Increased risk of what cancer with sjorgens?

1007
Q

CREST syndrome AKA

A

Limited cutaneous sclerosis

1008
Q

Antibody of limited cutaneous sclerosis (CREST)?

A

Anti centromere

1009
Q

Risk of what with CREST and anti centromere?

A

pulmonary HTN

1010
Q

Diffuse sclerosis antibody?

A

Anti SCl 70

1011
Q

Risk with anti Scl-70?

1012
Q

HLA B27 associated with?

A

A REAP

Ankylosing spondylitis
Reactive arthritis
Enteropathic arthritis
Anterior uveitis
Psoriatic arthritis

1013
Q

Osteoporosis T score?

1014
Q

What is subclavian steel syndrome?

A

Syncope on upper body exercise due to thoracic outlet obstruction

1015
Q

What is key to RA pathophysiology?

1016
Q

What does the Z score do?

A

diagnosing secondary osteoporosis

1017
Q

What is McArdle’s disease?

A

Myophosphorylase deficiency
seen as dark urine on exercise with myoglobin and CK

1018
Q

Pagets associated with increased?

A

hydroxyproline

1019
Q

Golimumab is a

A

TNF inhibitor

1020
Q

Causes of drug induced lupus?

A

procainamide
hydralazine
isoniazid
minocycline
phenytoin

1021
Q

Anti bodies of anti phsopholipid syndrome?

A

lupus anticoagulant
beta-2 glycoprotein antibody
cardiolipin antibody

1022
Q

Rheumatoid factor is an Ig what?

A

IgM antibody against IgG

1023
Q

Pilocarpine for?

1024
Q

How is lateral epicondylitis seen?

A

worse on resisted wrist extension/suppination whilst elbow extended

1025
Q

What is the most common cardiac defect in marfans?

A

dilation of the aortic sinuses

1026
Q

Mechanism of action of Mycophenolate mofetil?

A

inhibits inosine-5’-monophosphate dehydrogenase

1027
Q

Mechanism of action of methotrexate?

A

Reversible inhibitor of dihydrofolate reductase

1028
Q

If 75 and over with a history of fragility fractures what is the next stage in management?

A

Bisphosphonate without requiring a DEXA scan

1029
Q

Most common organism in osteomyelitits?

A

Staph aureus

1030
Q

Gout is most commonly caused by?

A

Decreased uric acid secretion

1031
Q

Positive femoral stretch test?

1032
Q

What secrets most of TNF?

A

Macrophages

1033
Q

SE of leflunoamide?

1034
Q

etanercept mode of action?

1035
Q

TNF-a can cause reactivation of?

1036
Q

CREST is associated with malabsorption because?

1037
Q

GCA vision loss most likely due to?

A

Anterior ischemic optic neuropathy (AION).

1038
Q

Azathioprine in pregnancy?

1039
Q

Osteoporosis in men check?

A

Testosterone

1040
Q

Mechanism of action of dabigatran and bivalrudin?

A

Direct thrombin inhibitors

1041
Q

Direct thrombin inhibitors have an increased?

A

APTT
Intrinsic

1042
Q

How does LMWH and fondaparinux work?

A

Activated anti thrombin III which inhibits Xa

1043
Q

How does apixaban and rivaroxaban work?

A

Direct Xa inhibitors

1044
Q

How does unfractionated heparin work?

A

Creates a complex inhibiting factors 9-12a

1045
Q

Reversal of unfractionated heparin?

A

Protamine sulphate

1046
Q

Reversal of apixaban?

A

Andexanet alfa

1047
Q

How does warfarin work?

A

Inhibits Vit K dependant factors:
2, 7, 9, 10
Protein S, C

1048
Q

Warfarin increases the?

A

PT
extrinsic

1049
Q

High INR no bleeding >5 but <8?

A

Hold 1-2 doses
Review maintanence dose

1050
Q

High INR no bleeding >8?

A

Stop anticoag
Oral or IV vitamin K
Repeat 24 hours

1051
Q

Minor bleeding with high INR?

A

Stop anti coag
IV vit K
Repeat 24 h

1052
Q

Major bleeding with high INR?

A

Stop anticoag
IV vitamin K
Prothrombin complex

1053
Q

Target cells?

A

Post splenectomy
IDA

1054
Q

Heinz bodies?

A

G6PD
Thalassaemia

1055
Q

Howell-Jolley bodies?

A

Post splenectomy

1056
Q

Schistocytes?

A

Haemolytic anaemia
HUS
DIC
TTP
Metallic heart valves

1057
Q

Sideroblasts?

A

Myelodysplastic syndrome

1058
Q

Causes of microcytic anaemia?

A

TAILS

Thalassaemia A + B
Iron deficiency
Lead poisoning
Sideroblastic

1059
Q

Blood findings in haemolytic anaemia?

A

High bilirubin
High LDH
High urobilinogen
Low haptoglobin

1060
Q

Inheritance of spherocytosis?

1061
Q

Causes of hereditary spherocytosis?

A

Low spectrin, ankyrin, band 3

1062
Q

Diagnosis of hereditary spherocytosis?

A

EMA binding

1063
Q

Crisis in hereditary spherocytosis caused by?

A

Parvovirus B19

1064
Q

Treatment of spherocytosis?

A

Folate
Splenectomy

1065
Q

Inheritance of G6PD?

A

X linked recessive

1066
Q

When can you do a G6PD assay for diagnosis?

A

6 weeks after crisis

1067
Q

Ig of warm autoimmune haemolytic anaemia?

1068
Q

Causes of WAHA?

A

Lymphocytic leukaemia
Lymphoma
Macrophages mark for destruction in spleen

1069
Q

Investigation of WAHA?

A

Flow cytometry
DAT +ve

1070
Q

Treatment of WAHA?

A

Prednisolone
Azathioprine

1071
Q

Ig of cold haemolytic anaemia?

1072
Q

Cold AHA action?

A

Complement direct haemolysis

1073
Q

A thalassamia types?

A

2 defects = carrier
3 defects = hb H anaemia
4 defects = hydrops fetalis

1074
Q

Thalssaemia inheritance?

1075
Q

B thalassaemia types?

A

Minor
Major - severe 3-9 months

1076
Q

Diagnosis of B thalassaemia?

1077
Q

Sickle cell diagnosis?

A

haemoglobin electrophoresis + genetic testing

1078
Q

management of sickle cell disease to stimulate HbF?

A

Hydroxycarbamide

1079
Q

Bloods in DIC?

A

High d-dimer
Schistocytes
Thrombocytopenia
High PT
Decreased fibrinogen

1080
Q

DIC linked to which leukaemia?

A

acute promyelocytic leukaemia

1081
Q

Platelets are produced by?

A

megakaryocytes

1082
Q

Plts <10?

A

Spontaneous intracerebral bleed

1083
Q

ITP is?

A

Immune destruction of plts due to glycoprotein Ib, IIb, IIa complexes

1084
Q

Management of ITP with plts <30 no bleeding?

1085
Q

Life threatening bleeding in ITP?

A

IV steroids
IVIG
Plts

1086
Q

TTP is caused by?

A

Low ADAMS13 activity cleaving VWF

1087
Q

management of TTP?

A

Plasma exchange

1088
Q

Haemophilia and VWD has high?

A

APTT intrinsic

1089
Q

Haemophilia inheritance?

A

X linked recessive

1090
Q

Haemophilia seen with?

A

Haemoarthrosis

1091
Q

Haemophilia A?

A

Factor 8 low

1092
Q

Haemophilia B?

A

Factor 9 low

1093
Q

Inheritance of VWF?

A

AD most common

1094
Q

VWD seen as?

A

Menorrhagia

1095
Q

Management of polycythaemia rubra vera?

A

Aspirin and venesection

1096
Q

ALL

1097
Q

CLL

A

Smear and smudge cells
Ritcher transformation to high grade lymphoma
Warm haemolytic anaemia

1098
Q

AML

A

Auer rods
15:17
PML-RARA
Good prognosis
DIC
Retinoic acid

1099
Q

CML

A

Philadelphia chromosome
9:22 34:11
BCR-ABL
Imatinib

1100
Q

BRAF

1101
Q

H. pylori and cancer?

A

MALT lymphoma

1102
Q

EBV and cancer?

A

Burkitts lyphoma

1103
Q

Hep C and cancer?

A

Diffuse large B cell lymphoma

1104
Q

Human T cell virus 1 and cancer?

A

T cell lymphoma

1105
Q

Poor prognosis in lyphoma?

1106
Q

Prognosis for myeloma?

A

serum B2 microglobulin
Albumin

1107
Q

poikilocytes in?

A

Myelofibrosis

1108
Q

Delivery and plts?

A

Epidural plts >80
NVD plts >50, avoid instrumental delivery

1109
Q

Anaphylaxis in blood transfusion?

A

IGA deficiency

1110
Q

Delayed haemolytic reaction to blood transfusion?

A

5 days after

1111
Q

What happens in factor V ledien?

A

activated factor V is inactivated 10 times more slowly by activated protein C than normal

AKA resistance to protein C

1112
Q

What is given to prevent haemorrhagic cystitis with cyclophosphamide?

1113
Q

Most likely SE with cisplatin (platinum based chemo)?

A

Ototoxicity

1114
Q

Pregnancy can cause which haemolytic anaemia?

1115
Q

Treatment of methaemoglobinaemia?

A

Methylene blue

1116
Q

Pancytopenia causes?

A

Trimethoprim
Chloramphenicol
Penicillamine
Carbimazole
Carbemazepine

1117
Q

TTP is seen as a pentad of?

A

thrombocytopenia
microvascular haemolysis
fluctuating neurological signs
renal impairment
fever.

1118
Q

Differentiating CML from leukaemoid reactions use?

A

leukocyte alkaline phosphatase score

LOW CML
High leukaemoid reaction

1119
Q

Follicular lymphoma translocation

A

t(14;18) translocation and increased BCL-2

1120
Q

How is common variable immunodeficiency seen?

A

Low IgG, IgM and IgA
High lymphocytes
B cell deficiency

1121
Q

SCID and lymphocytes?

1122
Q

basophilic stippling seen in?

A

Lead poisoning

1123
Q

Most common type of Hodgkin’s lymphoma?

A

Nodular sclerosing

1124
Q

Doxorubicin what serious SE?

A

Dilated cardiomyopathy

1125
Q

Vincristine mode of action and SE?

A

Inhibits formation of microtubles
Peripheral neuropathy

1126
Q

Burkitts lymphoma translocation?

A

c-myc gene translocation

1127
Q

CKD causes increased coagulopathy due to?

A

antithrombin III deficiency

1128
Q

Why is the hypercalcaemia in myeloma?

A

Increased osteoclast activation

1129
Q

Tumour marker of peritoneal ca?

1130
Q

Causes of intravascular haemolysis?

A

mismatched blood transfusion
G6PD deficiency
red cell fragmentation: heart valves, TTP, DIC, HUS
paroxysmal nocturnal haemoglobinuria
cold autoimmune haemolytic anaemia

1131
Q

Leucocyte alkaline phosphatase is raised in?

A

myelofibrosis
leukaemoid reactions
polycythaemia rubra vera
Steroids
pregnancy, oral contraceptive pill

1132
Q

Carcinogen linked to HCC?

1133
Q

Aniline dyes are a carcinogen for?

1134
Q

Nitrosamines are a carcinogen for?

A

Oesophageal, gastric ca

1135
Q

Most common cause of neutropenic sepsis?

A

Staphylococcus epidermidis

1136
Q

Staphylococcus epidermidis organism?

A

Coagulase-negative, Gram-positive bacteria

1137
Q

Bombesin is a tumour marker for?

1138
Q

Non hodgkins lymphoma chemo treatment?

1139
Q

Chemo used in CLL?

1140
Q

Waldenstrom’s macroglobulinaemia seen as?

A

IgM monoclonal paraprotein

1141
Q

Polycythaemia rubra vera and ESR?

1142
Q

Test for paroxysmal nocturnal haemoglobinuria?

A

Flow cytometry for CD59 and CD55

1143
Q

Capgras delusion?

1144
Q

Lithium >4?

1145
Q

Which antipsychotic is associated with high prolactin?

A

Risperidone

1146
Q

Clozapine SE?

A

Agranulocytosis

1147
Q

In IHD and depression give?

A

Sertraline

1148
Q

Section 2 in?

1149
Q

Section 4 in?

A

Emergency with 1 person

1150
Q

Section 135?

A

Enter property

1151
Q

Section 136?

A

Public place

1152
Q

Which antidepressants can cause urinary retention, dry mouth, blurred vision?

A

TCA
Amitriptyline
imipramine

1153
Q

Raised in anorexia?

A

G’s and C’s raised:

growth hormone
glucose
salivary glands
cortisol
cholesterol
carotinaemia

1154
Q

How long to stop SSRIs over?

1155
Q

Narcissistic personality disorder?

A

Self important
Lack of empathy
Takes advantage

1156
Q

Schizoid personality disorder?

A

Lack of interest in everything

1157
Q

Schizotypal personality disorder?

A

Odd beliefs

1158
Q

Antidepressant to avoid in overdose risk?

1159
Q

BZ mode of action?

A

Enhances GABA

1160
Q

Lithium levels should be checked every?

1161
Q

Safest TCA in overdose?

A

Lofepramine

1162
Q

Increasing pain management in palliative by?

1163
Q

Metastatic bone pain management?

A

Opioids
Bisphosphonates

1164
Q

Oral to SC/IV/IM morphine?

1165
Q

Oral morphine to codeine/tramadol?

1166
Q

Oral morphine to oral oxycodone?

1167
Q

Oral oxycodone to SC oxycodone?

1168
Q

Oral morphine to SC alfentanil?

1169
Q

Oral morphine to SC diamorphine?

1170
Q

12 fentanyl patch is how much morphine?

1171
Q

10 buprenoprhine patch is how much morphine?

1172
Q

PD end of life?

A

Rotigotine patch

1173
Q

If midazolam ineffective for agitation in end of life?

A

Levomepromazine

1174
Q

Treatment of hiccups in end of life?

A

Chlorpromazine

1175
Q

Liver capsular pain?

A

Dexamethasone

1176
Q

What increases mortality in dementia?

A

Antipsychotics

1177
Q

When to add on memantine?

1178
Q

LDH is the tumour marker for?

A

Testicular ca
NHL
HL

1179
Q

S-100 is the tumour marker for?

A

Melanoma
Schwannoma

1180
Q

B-2 microglobulin is the tumour marker for?

A

NHL
Myeloma

1181
Q

Seminoma testicular cancer tumour markers?

1182
Q

Etoposide chemotherapy can cause?

1183
Q

Hormonal therapy in breast cancer which is ER+ve?

A

Tamoxifen pre-menopausal
Anastrozole post menopausal

1184
Q

Trastuzumab is?

1185
Q

Germ cell ovarian tumours tumour markers?

1186
Q

What is a krukenberg tumour?

A

Ovarian tumour met from GIT with signet ring morphology

1187
Q

Asbestosis increases risk of what female GU cancer?

1188
Q

Cervical cancer linked to?

1189
Q

Never biopsy what cancer?

A

Testicular cancer promotes lymphatic spread

1190
Q

SLE is associated with which DAT +ve haemolytic anaemia?

A

Warm autoimmune haemolytic anaemia

1191
Q

What is defective in Chronic granulomatous disease?

A

Neutrophils

1192
Q

ALL good prognosis?

A

Hypodiploidy

1193
Q

CLL diagnosis?

A

Immunophenotyping

1194
Q

What is deficient in Hereditary angioedema?

A

C1-INH deficiency

1195
Q

Polycythaemia rubra vera can progress to?

A

Myelofibrosis
AML

1196
Q

Causes of drug induced methaemoglobinaemia ?

A

antimalarials (chloroquine, atovaquone)
co-trimoxazole
dapsone
local anaesthetics (benzocaine, lidocaine)

1197
Q

What is DDAVP?

A

Desmopressin

1198
Q

What is the mechanism of action of desmopressin in VWD?

A

release of von Willebrand’s factor from endothelial cells

1199
Q

Lung cancer in non smokers?

A

Adenocarcinoma

1200
Q

Adenocarcinoma of lung is found?

A

Peripherally

1201
Q

Why do you get repeated infections in CLL?

A

hypogammaglobulinaemia low IgA/ IgG/IgM

1202
Q

normocytic anaemia, gallstones and family history?

A

Hereditary spherocytosis

1203
Q

Poor prognosis in Hodgkins lymphoma?

A

B symptoms
Weight loss
Night sweats
Fver

1204
Q

Bone marrow/ stem cell transplant blood transfusions ensure you request?

A

Irradiated

1205
Q

CMV negative blood needed for?

A

Granulocyte transfusions
Intra-uterine
Neonates til 28 days
Pregnancy

1206
Q

Cisplatin mode of action?

A

cross-linking in DNA

1207
Q

6th CN palsy?

A

False localising effect
Raised ICP

1208
Q

Management of acute angle closure glaucoma?

A

IV acetazolamide/ timolol
+
Peripheral laser iridotomy

1209
Q

What prevents posterior synechiae?

A

Atropine or cyclophntolate

1210
Q

Episcleritis blanches with?

A

Pressure
10% phenylephrine

1211
Q

2 signs of central retinal artery occlusion?

A

Cherry red spot
Pale retine

1212
Q

Where is the occlusion in amourosis fugax?

A

Internal carotid artery

1213
Q

ARMD has?

A

Metamorphsia and drusen

1214
Q

Orbital cellulitis is?

A

Reduced VA
RAPD
Ptosis
Painful eye movements
Reduced colour vision

1215
Q

Retinoblastma has?

A

White pupil- leukcoria

1216
Q

Impaired light reaction to pupil but accomodation intact?

A

Argyll robertson

1217
Q

APD is called?

A

Marcus gunn pupil

1218
Q

Worst prognosis in age related macular degenration?

1219
Q

RA has increased risk of what eye condition?

A

Keratoconjunctivitis sicca
Dry eyes

1220
Q

Strongest risk factor for age related macular degernation?

1221
Q

Mechanism of action of pilocarpine?

A

muscarinic receptor agonist increasing outflow

1222
Q

Holmes aide pupil seen as?

A

Women
Absent leg reflexes
Dilated pupil

Benign

1223
Q

Mechanism of action of Dorzolamide?

A

Carbonic anhydrase inhibitor decreasing production

1224
Q

Treatment of Herpes zoster ophthalmicus (HZO)?

A

Oral aciclovir

1225
Q

Cause of horners syndrome that is post-ganglionic lesion?

A

Internal carotid artery

1226
Q

Scleritis and episcleritis which is painful?

1227
Q

Antioxidants not in?

A

Smokers increased risk of lung ca

1228
Q

In panretinal photocoagulation what % of patients reports decreased visual field?

1229
Q

How is Central retinal vein occlusion seen?

A

sudden painless loss of vision, severe retinal haemorrhages on fundoscopy

1230
Q

What is a monoclonal antibody directed against vascular endothelial growth factor (VEGF)?

A

Bevacizumab

1231
Q

Anhydrosis in horners absent in?

A

Carotid artery dissection

1232
Q

Causes of erythema nodosum?

A

IBD
Bechets
Sarcoidosis
COCP
TB

1233
Q

Causes of erythema mutliforme (target lesions)

1234
Q

Cellulitis cause?

A

Staph aureus
Strep pyogenes

1235
Q

Cause of erysipelas?

A

Group A B haemolytic strep

1236
Q

Treatment of lymes?

A

Doxycyline

1237
Q

Treating lymes can cause?

A

Jarisch-herxheimer reactions

1238
Q

HSV-1

A

Cold sores

1239
Q

HSV-2

1240
Q

Syphillis treatment?

A

Penicillin

1241
Q

Tinea under woods lamp?

A

Bright green

1242
Q

Actinic keratosis?

A

5-flourouracil

1243
Q

Bowens in immuncompromised?

1244
Q

Lichen planus?

A

P’s
Wickman striae

1245
Q

Bullous pemphigoid?

A

Deep
Subepidermal
IgG to hemidesmosomes
spares mucous membranes

1246
Q

Pemphigus vulgaris?

A

Superficial
Intraepithelial- desmoglein 3
IgG
Mucous membranes and nikolsky +ve

1247
Q

Photosensitive rash to dorsum of hands and face, associated with hair growth and pigementation?

A

Porphyria cutanea tarda

1248
Q

What is the cause of porphyria cutanea tarda?

A

uroprophyringen decarboxylase

1249
Q

Findings in uroporphyrinogen decarboxylase deficiency (inherited) porphyria cutanea tarda?

A

Pink urine under woods light
High ferritin

1250
Q

What else can cause prophyria cutanea tarda?

A

Inherited
Alcohol
Hep C
Oestrogen

1251
Q

Steroid ladder:

A

Mild: 1% hydrocortisone
Moderate: clobetasone butyrate 0.05%
Potent: betamethasone 0.1%

1252
Q

Seborrhoeic dermatitis is associated with?

A

HIV
Parkinsons disease
Blepharitis

1253
Q

What medication can worsen psoriasis?

1254
Q

Lichen planus oral involvement?

1255
Q

Dermatitis herpetiformis biopsy?

A

IgA deposition in the dermis

1256
Q

Hirtusim treatment?

A

Topical eflornithine

1257
Q

Lichen planus treatment?

A

Topical steroids

1258
Q

Acne abx in pregnancy?

A

Erythromycin

1259
Q

Isotretinoin SE?

A

teratogenicity
low mood
dry eyes and lips
raised triglycerides
hair thinning
nose bleeds

1260
Q

Non healing painless ulcer over site of trauma?

1261
Q

Dermatitis in hands, lips and perianal?

A

Zinc deficiency

1262
Q

Deep red ulcers with violaceous ulcer?

A

Pyoderma gangrenosum

1263
Q

Alopecia accreta treatment?

A

Corticosteroid topical

1264
Q

Flexural psoriasis first line treatment?

A

Topical steroids

1265
Q

Hazard ratio is?

A

Survival over time

1266
Q

Clinical trails stage 0-4?

A

0- exploratory
1- safety in healthy volunteers
2- dosing and efficacy
3- compare to standard
4- post marketing

1267
Q

What are confounding variables?

A

Non random distribution of risk factors

1268
Q

What is linear regression?

A

Predicts how much one variable changes when you change another
y = bx +a

1269
Q

Nominal data is?

A

Categories not in order e.g., birthplace

1270
Q

Ordinal date is?

A

Categories with order e.g.,HF classification

1271
Q

Discrete data is?

A

Finite number e.g., no. of asthma excacerbations

1272
Q

Continuous data is?

A

range e.g., weight

1273
Q

Interval data is?

A

Range with no true 0 e.g., temperature

1274
Q

Why is a funnel plot used?

A

Determine publication bias, unsymmetrical = bias

1275
Q

Incidence is?

A

No of new cases in a population over a period of time

1276
Q

What does intention to treat analysis remove?

A

Drop out bias

1277
Q

Type 1 error?

A

Incorrectly rejecting the null when it is true

1278
Q

Type 2 error?

A

Incorrectly accepting the null when it is false

1279
Q

Power =

A

1 - probability of a type 1 error

1280
Q

Cohort study is?

A

Observational and prospective

1281
Q

case control study is?

A

Observational and retrospective with matched control

1282
Q

Cross sectional study is looking at?

A

Prevelance

1283
Q

Normal distribution is?

A

Mean = Median = Mode

1284
Q

SD =

A

Sqaure root of variance

1285
Q

Standard error of mean =

A

SD / square root of n

1286
Q

95% CI is?

A

1.96 SD from mean

1287
Q

SD’s numbers:

A

1- 68.3% (34 each side)
2- 95.4%
3- 99.7%

1288
Q

When do you use parametric tests?

A

Normal distributions
Quantative data
Means and SD

1289
Q

Name the 2 parametric tests?

A

Students t-test (paired, unpaired)
Pearson’s coefficient (correlation)

1290
Q

What is a paired test?

A

Looks at one group with 2 values

1291
Q

What is an unpaired test?

A

Two different groups

1292
Q

When do you use a non parametric test?

A

Skewed, qualitative (nominal/ordinal)

1293
Q

Name the 4 non parametric test?

A

Mann whitney U- unpaired
Wilcoxon signed rank- paired
Chi squared- proportions, %
Spearman’s

1294
Q

How do you remember which non parametric test if paired or unpaired?

A

Mann Whitney U- whitney houston is not a man so unpaired

Wilcoxon- will is a man with a cox so paired

1295
Q

Sensitivity?

A

TP/TP + FN

1296
Q

Specificity?

A

TN/ TN+ FP

1297
Q

PPV?

A

TP / TP + FP

1298
Q

NPV?

A

TN/ TN + FN

1299
Q

NNT =

1300
Q

ARR is?

A

Absolute risk reduction

Control incidence - experimental incidence

1301
Q

RRR?

A

Control incidence

1302
Q

Risk ratio =

A

Experimental incidence / control incidence

1303
Q

Odds ratio =

1304
Q

Tuberous sclerosis inheritance?

1305
Q

Action of Vit D?

A

Increased calcium absorption in gut
Increases phosphate

1306
Q

Action of ADH?

A

Acts on collecting ducts to increase water reabsoprtion by increasing aqauporin 2 channels

1307
Q

What is penetrance?

A

Having the allele but no the phenotype

1308
Q

Chi sqaured for?

A

Non parametric nominal data

1309
Q

Tay sachs and Neiemann-Pick syndromes?

A

Developmental delay
Cherry red spot on macula

Neiemann- + hepato/splenomegaly

1310
Q

Tall with downward lens dislocation, DVT, tall, learning difficulties?

A

Homocsytinuria

1311
Q

X linked recessive conditions?

A

Duchennes
Beckers
Haemophilla
G6PD
Colour blindness
Fabrys

1312
Q

Trinucleotide repeat disorders?

A

Huntingtons
Freidrichs ataxia
Myotonic dystrophy
Fragile X syndrome

1313
Q

Vitamin B3 is?

1314
Q

What is niacin deficiency?

1315
Q

How is pellegra/ Niacin (B3) deficiency seen?

A

Dermatitis
Dementia
Diarrhoea

1316
Q

HLA’s are always on which chromosome?

1317
Q

What secretes GH?

A

Somatotropin cells

1318
Q

What does GH directly act on?

A

Chondrocytes and osteoblasts

1319
Q

What hormone is an anabolic steroid?

1320
Q

What does insulin bind to?

A

Tyrosine kinase receptors

1321
Q

HIV progression is seen by increased?

A

B3 microglobulin

1322
Q

2 actions of nitrates?

A

Smooth muscle relaxation causing vasodilation

Inhibits plt aggregation

1323
Q

Mitochondrial diseases show poor?

A

Penetrance

1324
Q

What receptor does EBV bind to?

1325
Q

Th cells secrete?

1326
Q

TNF is secreted by?

A

Macrophages

1327
Q

NK cells secrete?

A

Interferon gamma

1328
Q

What increases iron absorption in the gut?

A

Vit C (asorbic acid)

1329
Q

Treatment of minimal change disease?

1330
Q

Triad of von hippel lindau?

A

Retinal and cerebellar haemogioblastoma
Clear cell renal carcinoma

1331
Q

Post STEMI anti plt?

A

DAPT
Ticagrelor + aspirin

1332
Q

Enterobius vermiacaris?

A

Threadworm in children

1333
Q

Taenia solium?

A

Pork tape worm

1334
Q

Drugs causing peripheral neuropathy?

A

Vincristine
Amiodarone
Isoniazid
Nitrofuratoin
Metronidazole

1335
Q

Indinavir causes?

A

Nephrolithiasis

1336
Q

2 signs of spontaneous CJD?

A

Rapidly progressive mental deterioration
Myoclonus (often startle)

1337
Q

AED in breatfeeding?

1338
Q

Mixed alpha and beta adrenoceptor?

A

Carvedilol

1339
Q

Choice of intervention for severe MS in young?

A

Percutaneous mitral commissurotomy

1340
Q

Choice of intervention for severe MS in old with calcification?

A

Replacement

1341
Q

Antibiotic for legionella?

A

Clarithromycin

Legion = camp, camp= gives clarity

1342
Q

Action of clarithromycin?

A

Inhibits protein synthesis

1343
Q

NF1 findings?

A

Multiple neurofibromas
Cafe au lait spots
Lisch nodules
Optic gliomas

1344
Q

NF2 findings?

A

schwannomas and meningiomas

1345
Q

alexia (inability to read) is associated with lesion to the?

A

Corpus callosum

1346
Q

How do you offer HPV vaccination to?

A

MSM <45 to protect against anal, throat and penile cancers

1347
Q

Disseminated lymes treatment?

A

IV ceftriaxone

1348
Q

Mantoux and inferon +ve with no symptoms?

1349
Q

Management of latent TB?

A

3 months of isoniazid + pyridoxine + rifampicin

6 months of isoniazid with pyridoxine

1350
Q

Chikungunya symptoms?

A

Severe joint pain

1351
Q

Causes of occupational asthma?

A

isocyanates
platinum salts
soldering flux resin
glutaraldehyde
flour
epoxy resins
proteolytic enzymes

1352
Q

Nightmares?

A

Bisoprolol

1353
Q

Risk factors of aloopurinol SJS?

A

Diuretic use
Ethnicity (Thai descent)
Chronic kidney disease

1354
Q

IE abx til sensitivities return?

A

Amoxicillin and gentamicin

1355
Q

How long eating gluten for diagnostic tests?

1356
Q

Rapidly spreading rash from buttocks up?

A

Strongyloides stercoralis

1357
Q

Management of Strongyloides stercoralis?

A

Ivermectin

1358
Q

UC with severe relapse or 2+ exacerbations in past year treat with?

A

oral azathioprine or oral mercaptopurine

1359
Q

Raised inflammatory markers in UC severity?

1360
Q

Triggers for cluster headache?

1361
Q

Amiodarone rash?

A

Photosensitive rash on arms and face

1362
Q

Affect of amiodarone on the eyes?

A

Corneal opacities
Optic neuritis

1363
Q

What is uncommon in drug induced lupus?

A

Glomerulonephritis

1364
Q

Organophosphate insecticide poisoning tx?

1365
Q

Treatment of fast AF in WPW?

A

Flecanide

Avoid anything that inhibits AVN conduction AVN: CCB, BB, digoxin due to risk of VF

1366
Q

SEs of phenytoin?

A

Gingival hyperplasia
Peripheral neuropathy
Hirsutism
Coarsening of facial features
Megaloblastic anaemia
Osteomalacia
Lymphadenopathy
Dyskinesia

1367
Q

Filariasis that is brawny and indurated?

A

Wuchereria bancrofti

1368
Q

Statins or ezetimibe in pregnancy/ trying to conceive?

1369
Q

Medication overuse headache treatment?

A

Slowly decrease opioids, stop NSAID and paracetamol now

1370
Q

Marfans optic issue?

A

Superotemporal ectopia lentis (upward lens dislocation)

1371
Q

First line for neuropathic pain?

A

Amitriptyline

1372
Q

Second line for neuropathic pain, when amitriptyline contraindicated due to BPH/ risk of urinary retention?

A

Pregabalin

1373
Q

Kallman vs Klienfelter?

A

Both low testoesterone

Kallman Low LH and FSH, no smell
Klienfelters High LH and FSH

1374
Q

Gitelman’s affects the?

1375
Q

Granuloma inguinale is due to?

A

Klebsiella granulomatis

1376
Q

What is a chancroid?

A

Haemophilus ducreyi.

painful genital ulcers, painful inguinal lymph node enlargement.

1377
Q

What is Lymphogranuloma venereum (LGV)?

A

Chlamydia trachomatis.

small painless pustule which later forms an ulcer

1378
Q

Medications linked to poor glycaemic control?

A

thiazides
steroids
tacrolimus, ciclosporin
interferon-alpha
nicotinic acid
antipsychotics

1379
Q

Parietal lobe lesions can cause?

A

Astereognosis
Inability to recognise things

1380
Q

Ethyl gycol poisoning on ABG?

A

RAGMA and high osmolar gap

1381
Q

Mechanism of action of sumitriptan?

A

5-HT1 agonist

1382
Q

Mechanism of action of pilocarpine for dry mouth?

A

Muscarinic agonist

1383
Q

Steroids can cause?

A

Drug adverse effect of acne like spots

1384
Q

Adverse effect of long term steroids?

A

Avascular necrosis

1385
Q

centrally acting anti hypertensive?

A

Moxonidine

1386
Q

Associations with WPW?

A

HOCM
mitral valve prolapse
Ebstein’s anomaly
thyrotoxicosis
secundum ASD

1387
Q

Shift to the R in oxygen dissociation curve?

A

Raised [H+] (acidic)
Raised pCO2
Raised 2,3-DPG
Raised temperature

1388
Q

Drugs causing urticaria?

A

aspirin
penicillins
NSAIDs
opiates

1389
Q

Causes of restrictive cardiomyopathy?

A

Amyloidosis (most common), Haemochromatosis
Loffler’s syndrome
Sarcoidosis
Scleroderma

1390
Q

Ankylosing spondylitits is associated with which valvular problem?

A

Aortic regurg

1391
Q

William syndrome is associated with?

A

Supravalvular AS

1392
Q

Reversal of dabigatran?

A

idarucizumab

1393
Q

Drug causes of intracranial HTN?

A

combined oral contraceptive pill
steroids
tetracyclines
Isotrenonin
lithium

1394
Q

Gram negative cocci?

A

Neisseria meningitidis
Neisseria gonorrhoeae
Moraxella catarrhalis

1395
Q

What is Gerstmann syndrome?

A

acalculia
right-left disorientation
finger agnosia
agraphia

1396
Q

Where is the lesion in Gerstmann syndrome?

A

Dominant parietal lobe

1397
Q

tirofiban pre PCI mechanism of action?

A

Glycoprotein IIb/IIIa receptor antagonis

1398
Q

Early x-ray feature of RA?

A

Juxta-articular osteoporosis/osteopenia

1399
Q

T2DM not controlled on triple therapy?

A

switch one of the drugs for a GLP-1 mimetic, particularly if the BMI > 35

1400
Q

T wave inversion in V1-3 with notch at end of QTc (AKA epsilon wave)?

A

Arrhythmogenic right ventricular cardiomyopathy

1401
Q

Protein on urine dip on kidney dysfunction rules out?

A

Pre or post renal causes

1402
Q

Psoriatic arthritis affects?

A

Males and female equally

1403
Q

72 hours post op without pyrexia with new o2 requirement think?

A

Atelectasis

1404
Q

If you cant give ciprofloxacin to meningitis contacts give?

A

Rifampicin

1405
Q

Can mothers with Hep B breast feed?

1406
Q

How to look after baby born to mother with Hep B?

A

At birth hepatitis B immunoglobulin (HBIG) within 24h hepatitis B vaccine

1407
Q

Bile acid malabsorption test?

1408
Q

What are the risk factors for oesophageal adenocarcinoma?

A

Barrett’s oesophagus
Smoking
Alcohol

1409
Q

What are the risk factors for oesophageal squamous cell carcinoma?

A

Smoking
Alcohol
Plummer vinison
Achalasia

1410
Q

PCP on examination?

A

Very little chest signs to auscultate

1411
Q

Recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with?

A

oral fidaxomicin

1412
Q

AD PCKD type 1 chromosome?

A

chromosome 16

1413
Q

AD PCKD type 2 chromosome?

A

Chromosome 4

1414
Q

Gitelman’s syndrome mechanism?

A

NaCl symporter in the DCT

1415
Q

Suspect meningitis start?

A

cefotaxime IV

1416
Q

Plasma exchange complication?

A

Hypocalcaemia

as it is chelated by sodium citrate, the agent used as an anticoagulant during the procedure

1417
Q

Mechanism of action of procyclidine?

A

Anti muscarinic

1418
Q

Treatment of Varicella pneumonia?

A

IV aciclovir

1419
Q

Warfarin in breast feeding?

1420
Q

What abx inhibit protein synthesis?

A

Clarithromycin
Erthromycin
Gentamicin
Doxycycline

1421
Q

Delayed gastric emptying can be seen in?

1422
Q

SLE disease monitoring?

A

Anti-dsDNA titres

1423
Q

Hodgkin lymphoma has which CD?

1424
Q

What type of hypersenstivity reaction is ITP?

1425
Q

HLA DR2?

A

Good pastures

1426
Q

Friedrichs ataxia?

A

AR - recessive

1427
Q

Large pulse pressure in older age is due to? (difference between systolic and diastolic)

A

reduced aortic compliance

1428
Q

HLA- DRB1?

A

Rheumatoid arthritis

1429
Q

Turners syndrome cardiac problems?

A

aortic dilatation and dissection

1430
Q

Vincristine acts during which cell cycle phase?

1431
Q

What is the normal action of p53?

A

preventing entry into the S phase until DNA has been checked and repaired

1432
Q

When proteins in the cell have been marked with ubiquitin they go to the?

A

Proteasome

ubiquitin-proteasome system (UPS)

1433
Q

How do you calculate likelihood ratio of a positive test?

A

sensitivity / (1- specificity)

1434
Q

Central chemoreceptors work due to?

1435
Q

Turners syndrome associated with which cardiac defect?

A

Coarctation of the aorta
Aortic dilatation
Aortic dissection

1436
Q

Vincristine acts on which cell cycle?

1437
Q

What is the normal action of p53?

A

Preventing entry into the S phase until DNA has been checked and repaired

1438
Q

Large pulse pressure in older age is due to?

A

Reduced aortic compliance

1439
Q

HLA-DRB1?

A

Rheumatoid arthritis

1440
Q

Homocystinuria is caused by a deficiency of?

A

cystathionine beta synthase

1441
Q

Cubital tunnel syndrome affects which nerve?

1442
Q

How to remember molecular tests?

A

SNOW
DROP

South, North, West
DNA, RNA, proteins

1443
Q

Action of NO?

A

vasodilation + inhibits platelet aggregation

1444
Q

RNA splicing occurs in the?

1445
Q

Cardiac issues in downs syndrome?

A

endocardial cushion defect (AVSD)
VSD
Secundum atrial septal defect
tetralogy of Fallot
isolated patent ductus arteriosus

1446
Q

Wrist drop seen due to injury to?

A

Radial nerve

1447
Q

Hypothenar wasting?

A

Ulnar nerve

1448
Q

Pain and temp are in the?

A

Spinothalamic tract

1449
Q

Pain and temp of spinothalamic cross?

A

at level of spinal cord

  • what you have to respond quickly to
1450
Q

Hypotension in sepsis due to?

1451
Q

Activation of B cells via?

1452
Q

Name the 4 steps of cardiac action potential?

A

4- resting Na/K ATPase
0- depolarisation- Na IN
1- early repolarisation- K out
2- plateau Ca slowly in
3- repolarisation- K out

1453
Q

Hypersensitivity reactions?

A

1- anaphylaxis IgE
2- Cell bound
3- immune complex
SLE, PSGN
4- delayed
scabies
Allergic dermatitis
GvHD
TB

1454
Q

Where does levothyroxine act?

A

Nuclear receptors

1455
Q

What does digoxin do to the QT interval?

A

Shortens it

1456
Q

What does digoxin act on?

A

Na/K ATPase

1457
Q

Digoxin toxicity is more likely in which electrolyte disturbance?

1458
Q

Cyanaid poisoning treat with?

A

Hydroxocobalamin (b12)

1459
Q

Metformin mechanism of action?

A

activation of the AMP-activated protein kinase (AMPK)

1460
Q

Alcohol in a paracetamol overdose?

A

Protective

1461
Q

What increases the risk of lithium toxicity?

A

Thiazides
ACEi

1462
Q

Cocaine causes what temp chnage?

A

Hypertehermia

1463
Q

Furosemide may cause hypo?

1464
Q

When do you take lithium levels?

A

12 hours post dose

1465
Q

Treatment within an hour of aspirin overdose?

1466
Q

TIA confirmed medications?

A

Aspirin + clopidogrel

1467
Q

Test for family members of haemochromatosis?

1468
Q

Large jaw tumour?

A

Burkitts lymphoma

1469
Q

Burkitts lymphoma translocation?

1470
Q

S4 is inkeeping with?

1471
Q

Spike and dome appearance on renal biopsy?

A

Idiopathic membranous glomerulnephritis

1472
Q

Antibodies in idiopathetic membranous glomerulonephritis?

A

Anti-phospholipase A2 antibodies

1473
Q

Drug induced lupus medication aganist TB?

1474
Q

Good pastures defective of which collagen?

A

Collagen IV

1475
Q

What activates macrophages?

A

Interferon- y

1476
Q

Treatment of GAD?

1477
Q

Purplish macules in HIV+ve?

A

kaposi sarcoma

1478
Q

What virus is causing kaposi sarcoma in HIV +ve pts?

1479
Q

What produces somatotrophin?

1480
Q

What causes eczema herpiticum?

A

HSV-1
Cocksakie

1481
Q

Widening of wrists?

1482
Q

What decreases levotyroxine if taken together/ within 4 hours?

A

Ion and calcium

1483
Q

What causes congenital adrenal hyperplasia?

A

21-hydroxylase deficiency

1484
Q

Basilar artery stroke?

A

Locked in syndrome

1485
Q

Amurosis fugax?

A

retinal or opthalamic artery

1486
Q

Gynaecomastia can occur in?

1487
Q

Poor prognosis in MS?

1488
Q

Psoriasis is worsened by which drugs?

A

Hydroxychloroquine
Lithium

1489
Q

Japanese encephalitis affects the?

A

Basal ganglia

(PD signs in encephalitis)

1490
Q

Methaemoglobinaemia is the?

A

oxidation of Fe2+ in haemoglobin to Fe3+

1491
Q

What causes hirtusim?

1492
Q

Where is the medial longitundial fasiculus?

A

Paramedian midbrain and pons

1493
Q

Which treatment for osteoporosis is a RANKL inhibitor?

1494
Q

What chromsome is affected in NF2 with bilateral schwanomas?

A

Chromosome 22

1495
Q

What is the most common cause of inherited colon cancer?

A

HNPCC (lynch)

1496
Q

Seborrhoic dermatitis is more common in?

1497
Q

What test do you do for prognosis of AML?

A

Cytogenetics

1498
Q

Which infection causes rash sparing hands and feet?

1499
Q

How do you treat tyhpus?

A

Doxcycline

1500
Q

Long QT syndrome is caused by?

A

Loss of function of K cells

1501
Q

Ulcer with purple violaceous border?

A

Pyoderma gangrenosum

1502
Q

What is the treatment of pyoderma gangrenosum?

1503
Q

What is the inheritance of charcot marie tooth?

1504
Q

Phenytoin causes macrocyctic anaemia by?

A

Folate deficiency

1505
Q

Biopsy of HSP renal?

A

Mesangial hypercellularity

1506
Q

Which antibiotics inhibit 50S?

A

Macrolides
Clarithromycin, erythromycin

Cardiology (3 decks)

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