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MRCP Part 1 > MRCP PCT > Flashcards

MRCP PCT Flashcards

1
Q

Role of protein C

A

inactivate factor 5a and 8a

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2
Q

Meptazinol

A

mu opioid partial receptor agonist
low constipation rate

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3
Q

Antiemetics that cause prolonged QT

A

metoclopramide
ondansetron
prochloperazine

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4
Q

Zolendronic acid can be pain control for…

A

Bone pain with bone mets

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5
Q

Fentanyl patch useful in…

A

stable morphine who cannot take due to side effect or poor renal fx

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6
Q

Renal function for fentanyl patch

A

safe in eGFR <30

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7
Q

Diazepam acts on…

A

GABA-A

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8
Q

MND patients with respiratory distress at end of life…

A

NIV improves comfort

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9
Q

Glycopyrronium side effect

A

dry mouth

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10
Q

Cytotoxic agent that causes cardiomyopathy…

A

doxirubicin
herceptin

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11
Q

Anaplastic thyroid cancer (poor prognosis) spread to…

A

LUNGS mostly

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12
Q

Liver capsule pain can be managed by…

A

Dexamethasone

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13
Q

Gabapentin bings to…

A

alpha 2 delta of VGCaChannel

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14
Q

`

serotonin syndrome vs neuroleptic malignant syndrome

A

hyperreflexia vs hyporeflexia

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15
Q

Side effect on ondasetron

A

constipation

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16
Q

Antiemetics contraindicated in PD

A

haloperidol
metoclopramide

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17
Q

Steroid side effect

A

psychosis

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18
Q

Side effect of amitriptylline

A

anti-cholinergic effects

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19
Q

Laxative for opiate induced constipation

A

First: Stimulant laxative (Senna)
Second: Osmotic (macrogol/lactulose)
Third: docusate if colic

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20
Q

Hyoscine (buscopan) side effect

A

dry mouth

anticholinergic

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21
Q

Breakthrough pain with synringe driver

A

subcut morphine

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22
Q

DNAR

A

medical decision

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23
Q

side effect of fentanyl…

A

generalised itching and sweating and rash

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24
Q

Option for local pain management in pancreatic cancer when PCM, ibu, MST does not work

A

coeliac plexus block

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25
Q

WHO pain ladder

A

Para –> ibu –> weak opioid (codeine/dihydrocodeine/tramadol) –> morphine

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26
Q

CKD patient pain relief

A

oxycodone not morphine

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27
Q
A
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28
Q

Drug that increases life expectancy in MND

A

Riluzole

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29
Q

240mg codeine to morphine

A

20mg morphine

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30
Q

Antiemetic receptors

A

Ondansetron= 5HT
Domperidone=dopamine antagonist
Metoclopramide=dopamine antagonist
Aprepitant = nk-1 receptor (chemo related N+V)

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31
Q

Morphine conversion

A

Oral morphine /2 : sc morphine , oral/sc oxycodone
Oral morphine /3 : sc diamorphine
Morphine 12 mg : buprenorphine 5microgram
Morphine 30mg : 12 fentanyl
Breakthrough ⅙ to 1/10th of regular morphine .
codeine/tramadol to oral morphine = divide by 10

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32
Q

Marie curie nurses

A

help those who wish to die at home

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33
Q

Prognosis discussion

A

if patient does not want to know do not inform

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34
Q

Treatment for Colicky pain

A

hyoscine

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35
Q

oral morphine –> subcut morphine

A

divide oral morphine by 2
(takes into account surpassing first pass metabolism)

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36
Q

Fluids in EOL

A

may cause fluid overload
does not affect rate / timing of death

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37
Q

Severe hyponatraemia <125

A

SEIZURES

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38
Q

Bleomycin toxicity

A

pneumonitis

non productive cough, SOBOE, bibasal creps

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39
Q
A
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40
Q

Adrenal metastasis

A

hypoadrenalism
abdo pain, vomit, weakness
low BP
low Na
high K

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41
Q

Side effect of amiodarone

A

hepatotoxicity
pulmonary fibrosis
thyroid issues
prolonged QT
pancreatitis
CORNEAL DEPOSIT

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42
Q

Cisplatin side effects

A

ototoxic
hypocal
hypomag
hypokal
nephrotoxic

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43
Q

FEV1 contraindicated for pneumonectomy

A

FEV1<2 in pneumonectomy
FEV1<1.5 for lobectomy

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44
Q

lorazepam low dose

A

useful in SOB

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45
Q

CPR with PE

A

continue CPR for 60-90 min post fibrinolysis (unless ROSC) to allow PE to dissolve

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46
Q
A
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47
Q

trastuzumab….

A

can cause dilated cardiomyopathy
hence HF

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49
Q

Antiemetic for hypercalcaemia

A

Haloperidol (D2 antagonist)
Second line: metoclopramide (acute dystonia side effect)

50
Q

Chemo antiemetics

A

cyclizine
ondansetron

51
Q

Diazepam

A

muscle spasm

52
Q

Acinic keratosis management (atypical keratinocyte)

A

topical 5-FU

53
Q

LBD

A

triad:
fluctuating confusion
persistent visual hallucination
spontaneous parkinsonism

note: extreme reaction to neuroleptics

54
Q

What is nitrate tolerance

A

increases reactive oxygen spp from vascular oxidative stress–~> inhibiting activation of nitrate

54
Q

Myeloproliferative diseases
- too many cells from bone marrow

A

Polycythaemia vera
CML
Myelofibrosis
Essential thrombocytosis

55
Q

Lymphoproliferative disease

A

CLL
Follicular lymphoma
DLBCL

56
Q

Myelodysplastic syndrome
- abnormal dysfunction cells from marrow - low counts

A

ring sideroblast
HIGH BLAST CELLS

57
Q

Restless leg syndrome

A

discomfort in legs and urge to move
better with movement
crawling feeling
iron deficiency associated

58
Q

P450 inducer - decreases INR

A

rifampicin
phenytoin
carbamazepine
st johns wort

59
Q

P450 inhibitor - increases INR

A

erythromycin
metronidazole
ciprofloxacin
allopurinol

60
Q

Legionella transmission via..

A

warm water source via aerosol

61
Q

Management of LBD

A

rivastigmine (cholinesterase inhibitor)

62
Q

Thiazide diuretic…

A

hypercalcaemia
worsening glucose tolerance
low potassium/sodium/magnesium
hypochloraemic alkalosis

63
Q

squamous cell carcinoma of skin

A

ulcerated nodular lesion
surrounding parathesia and hyperkeratosis
Mx: surgical excision (risk of LN mets)

64
Q

Reverse splitting of S2

A

AS
HOCM
LBBB

65
Q

Giant v wave

A

tricuspid regurg

66
Q

variable S1

67
Q

Heparin induced thrombocytopenia

A

risk of venous thrombotic event

68
Q

SIADH

A

urine sodium >40
urine osmolality HIGH

69
Q

MI

A

LAD - anterior
LCx - lateral
RCA - inferior

70
Q

Listeria meningitis

A

Low glucose
high protein
lymphocytic

71
Q

TB management

A

RIPE for 4 months
RI to continue for 2 further

72
Q

TB management in deranged LFT (liver friendly regimen)

A

streptomycin/moxifloxcin

73
Q

What is creatitine

A

cation
drugs can interfere with creatinine secretion–> lead to self limiting and reversible rise in creatinine without changing eGFR
e.g trimethoprime and cimetidine

74
Q

Normal pressure hydrocephalus

A

trial of CSF removal

75
Q

Gait in parkinsons

A

NARROW short shuffling gate

76
Q

Donepazil in alzheimers

A

acetylcholinesterase inhibitor

77
Q

Rasagiline in parkinsons

A

MAO B inhibitor

78
Q

Medication increasing risk of GOUT

79
Q

Mechanism of digoxin

A

inhibit sodium potassium ATPase in sarcomere

80
Q

Why is there delay in digoxin action (few days)

A

digoxin binds to proteins and widely distribute in body tissues

81
Q

Management for CLL

A

First: FCR combination therapy
- fludaraine,
- cyclophosphamide,
- rituximab

Second: Alemtuzumab (CD52)

82
Q

Osteomalacia

A

low vit D –> low calcium –> PTH increase (secondary) –> trashing phosphate

83
Q

High ALP in osteomalacia

A

due to increased osteoblasts

84
Q

Delirium vs dementia

A

fluctuating impaired consciousness => acute delirium

85
Q

age >65 vaccine

A

yearly influenzae
one off pneumococcal

86
Q

Surgical management of aortic stenosis…

A

based on clinical sx - syncope chest pain worsening LVF

87
Q

Potassium sparing diuretics

A

amiloride
spironolactone

88
Q

homonymous hemianopia

A

contralateral occipital lesion (posterior cerebral artery)

note: macular sparing as macular collaterals from MCA

89
Q

Empirical abx for meningitis in >65/immunocompromised

A

meningococcal and pneumococcal and listeria

cef, amox, aciclovir

90
Q

causes of RBB

91
Q

causes of LBB

A

CAD
AS
HOCM
MI

92
Q

Huntington disease

A

caudate nucleus
chorea

CC

93
Q

Hippocampus

A

memory
temporal lobe epilepsy
schizophrenia

94
Q

Thalamus

A

sleep regulation
eye saccade movement

95
Q

Cirpofloxacin side effect

A

Tendo rupture

96
Q

Stroke management

A

rule out haemorrhage with CT
past 4.5hr -> aspirin 300
switch to clopi 75 after 2 weeks
within 4.5hr -> alteplase

97
Q

Common cause of TIA

A

carotid artery steonsis

98
Q

Lacunar infarct

A

persistent focal deficits
no changes in initial imaging

99
Q

commonest cause of AS

A

young- bicuspid
old- calcification

100
Q

Amiodarone action

A

K channel antagonist
–> delay depol
–> increase refractory period

101
Q

NaBKCa

A

Na - lidocaine, flecainide
B- bisoprolol
K- amiodarone, sotalol
Ca - verapamil, diltiazem

102
Q

Halflife of amiodarine

A

long (up to 1 month)
therefore needs loading dose

103
Q

Digoxin toxicity

A

vomiting
confusion
yellow visual field

104
Q

Management of MSRA s.aureus

A

asymptomatic- topical decolonisation (risk of spread to others)

invasive -> IV vanc

105
Q

Management of hallucination and agitation in parkinson

A

low dose atypical antipsychotic
- quetiapine

avoid typical antipssychotics (has anti-dopamine effect)

106
Q

Entacapone (to prevent OFF)

A

COMT inhibitor
- prevent breakdown of levodopa in brain

107
Q

Alzheimers management

A

Mild to moderate
- acetylcholinesterase inhibitor
donepezil
rivastigmine
galantamine

Severe (MMSE <10 and ADL)
- memantine

108
Q

Irradiated RBC for…

A

on chemo (purine analogue)
–> reduced T cell
–> risk of transfusion associated GVHD

109
Q

Weber syndrome

A

third nerve palsy
contralateral hemiparesis
midbrain lesion
at base!
basillar

110
Q

anterior communication cerebral artery stroke

A

optic chiasm
visual field defect

111
Q

Vertebral artery dissection (stroke)

A

PICA–> lateral medullary syndrome

112
Q

Why is NIV contraindicated in hypotension

A

reduced venous return and cardiac output

–> due to high lung pressures

113
Q

carcinoid syndrome common sx

A

Diarrhoe
fascial flushing

114
Q

What medication can you add in parkinsons to reduce dyskinesia

A

amantadine
NMDA receptor

115
Q

Side effects of levodopa

A

dyskinesia

116
Q

loperamide

A

Exclude infective gastroenteritis first

117
Q

Parkinsons plus

A

PD- tremor, asymetric, late postural instability

LBD

PSP- early falls + postural instability, verical supranuclear gaze palsy, symmetrical axial and limb parkinsonism

MSA- postural hypotension

MRCP Part 1 (17 decks)

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