MRCP Pt 1 Flashcards
Number needed to treat formula?
NNT= 1 / (CRR-EER)
Medication which may exacerbate syncopal episodes in a pt with AS?
Bisoprolol - beta blockade means LVF is reduced, but in AS, the heart may just need to work that bit harder to overcome the increased pressure so that it can maintain CO
AntiTb drug that increases hydrocortisone requirements?
Rifampicin - because it is a p450 enzyme inducer, including corticosteroid metabolism
Treatment for hypocalcaemia (especially with hungry bone syndrome)
IV calcium gluconate
Cause of cortical blindness?
B/L occipital lobe infarcts, especially in periods of prolonged hypotension. Often with preservation of pupillary reaction to light
Anton syndrome
when patients with cortical blidnness deny their dieases and confabulate visions
large increases in insulin can drive reduction in which electrolytes?
phosphate, potassium and magnesium
consequences of hypophosphataemia
muscle weakness cardiac failure, neurological dysfunction, including seizures
Anti-smooth muscle antibody is associated with?
Autoimmune hepatitis
By what mechanism does lithium cause nephrogenic DI?
through decreased aquaporin-2 expression
What kind of bias has the biggest impact on interpretation of meta-analyses?
publication bias - tendency to only submit positive trials and for joirnals to favour publication of positive studies
selection vs attrition vs performance bias
selection: systematic differences in the baseline characteristic of two groups of subjects entering a study
attrition: systemic differences between groups in withdrawals from a stufy
performance: systematic differences in the care provided to 2 groups of pts in a study
carry-over bias
occurs in crossover trials , where the first tx may impact the performance of the 2nd
coag studies in haemophilia A
significant prolongation of ATPP
chronic headaches, lethargy, foci of bleeding and increased risk of thrombosis is associated with?
essential thrombocythaemia
how many cal/kg does a typical person need per day?
25-35/kg
how quickly can hydrocephalus set in after a SAH?
as early as 24h after the initial haemorrhage and build slowly over hours to days
headache, seizure, papilloedema, depressed level of consciousness
think cerebral venous sinus thrombosis
complication of cerebral venous sinus thrombosis
SAH
complication of SAH
hydrocephalus, cerebral ischaemia, re-bleed
acutely painful red eye with cloudy anterior chamber is likely?
anterior uveitis
Mx of anterior uveitis
topical corticosteroids, systemic corticosteroids may be needed if has chronic uveitis
gritty eyes, no loss of vision
episcleritis
red eye, pain worse at night and on movement of the eye
scleritis
JVP: dominant vs absent a waves
dominant: INCREASED atrial contraction ie when there is tricuspid/pulmonary stenosis
absent: MINIMAL atrial contraction , think in AF
JVP: Prominent vs absent X descent
X descent: occurs after A wave, corresponds with atrial relaxation and rapid atrial filling due to low pressure
Prominent: cardiac tamponade
Absent: tricuspi stenosis
JVP: Dominant V waves
V waves - venous filling of RA when tricupsid valve is closed. Seen in tricuspid regurgitation /ASD
conditions for use of liraglutide for weight loss?
BMI >35, non-diabetic hyperglycaemia, high risk factors of CVD eg HTN/dyslipidaemia
management of psychotic symptoms in PD
- quetiapine
- clozapine (dopamine antagonist) - imporves psyh sx and reduces tremor
for how long must CPAP be used overnight to have an adequate effect for those with OSA
> =4 hours
identifying reticulocytes vs erythrocytes
reticular staining with methylene blue of ribosomal ribonucleic acid . erythrocytes DNH ribosomal ribonucleic acid
Heinz body vs Howell jolly body
Heinz - seen in G6PD deficiency, composed of denature Hb
Howell Jolly - markers of hyposplenism, composed of small inclusions of basophulic nuclear material
lupus is a/w which complement deficiencies
C1q, C1r, C2, C4
DID YOU KNOW THAT REARRANGED DURING TRANSFECTION is long for the RET proto-oncogene? Anyway what condition is this associated with
MEN 2A, MEN 2B, familial medullary thyroid cancer
weird proto-oncogenes:
C-KIT
Kirsten rat sarcoma
C-KIT - activates mutations for seminomas and gastrointestinal stromal tumours
Kirsten - lung adenocarcinoma, pancreatic ca, colorectal ca
conditions associated with wide vs narrow vs reverse splitting of S2
(hint: go from right to left)
wide: VSD or RBBB
narrow: pulm HTN
reverse: WPW or HTN heart dx or LBBB
aetiology testing for contact dermatitis
patch testing
radioallergosorbent test
mx for pruritus a/w liver failure
cholestyramine - its a bile acid sequestrant. in LF, accumulation of bile acids is what causes the itching.
otherwise may try to use rifampicin if that doesnt work
involuntary tics, echolalia, palilalia, coprolalia, difficulty concentrating made worse by periods of stress
tourette syndrome
Elevated LDH and 1-3 beta -d-glucan in a pt with HIV - what tx options are there
thisis pneumocystis jirovecii. Tx is co-trimox, then pentamidine if that doesnt work/severe dx
interleukin that drives NK cell activation?
IL-12
MoA of allopurinol
Xanthine oxidase inhibitor - purine analogue. did u know - these kinds of meds may also reduce progression of diabetin nephropathy
most common place for a cardiac myxoma
LA - around 75-80%
rash at the dorsum of the hand, consisting of a ring of papules, each 1-2mm in diameter. NOT ITCHY. dx + tx?
granuloma annulare - will self resolve in a few months, but may use intralesional steroids
single erythematous nodula lesion. pt works with fish tanks.
mycobacterium marinum
traveler who stupidly drank local stream water. ongoing sx >1 week. abdo bloating, sulphurous burping, intermitten diarrhoea. dx + tx?
giardiasis. 1x dose of tinidazole
tx for lupus nephritis vs lupus with more joint features?
mycophenalate for nepritis. hydroxychloroquine for joint disease
formula for sensitivity
sensitivity= true positive/ (true positives + false negatives AKA the total number of positive result from the test)
in acute asthma, after back to back nebulised salbutamol what is recommended and what is NOT recommended (2x)?
recommended: IV magsulf
NOT recommended: IV aminophylline. WHY? limited additional impact wrt bronchodilation and increases the risk of arrhythmias.
IV hydrocortisone - needs 6hrs to work bruh by that time pt dead
anti hypertensives that can cause oedema
amlodipine, doxazosin
alpha blockers are not recommended in patients with….?
reduced ejection fraction, bc it increases the risk of cardiac failure
proximal myopathy, raised ALP, borderline low calcium, decreased phosphate
think vitamin d deficiency
ERB-B2/HER2 inhibitors (eg trastuzumab) increase likelihood of ….?
dilative cardiomyopathy. HER2 receptors are thought to be preventative for this condition
Patients on trastuzumab therefore require what investigation?
ECHO before and during therapy
what is oxoliplatin commonly administered with for colorectal carcinoma?
folinic acid and fluorouracil
what is the common adverse effect for patients receiving oxoliplatin?
sensory polyneuropathy. Also ototoxicity, myelosuppresiona nd GI toxicity
agoraphobia vs social phobia
agoraphobia - fear of places where you cannot freely escape
l’illusion des sosies
an illusion of seeing doubles IE thinking someone close to you is an imposter
Which ssri’s are suitable for panic disorders?
paroxetine and citalopram
HPV is associated with what cancers?
anal cancer and cervical cancer
incubation period of hep b vs hep a
hep b - upto 4 months. hep a - 2-6 weeks
characteristic symptoms of leptospirosis
headache, fever, mylagia, SUBCONJUNCTIVAL effusions, jaundice (liver failure). Bleeding is not as prominent as in hantavirus infection
where is yellow fever endemic?
africa and south ¢ral americs
typical illness course of yellow fever
flu-like illness with severe fever –> gets better –> fever again but also jaundiced and bleeding bc hepatomegaly
weil disease???
severe form of leptospirosis, presentsw after the initial illness seems to have resolved. a/w with meningitis, hepatic failure, kidney injury
congenital vzv infection vs congenital cmv infection
vzv: shingles, low birth weight, eye abnormalities
cmv: jaundice, pneumonia, seizures, microcephaly
associated bloodwork results of antiphospholipid
anti cardiolipin, anti lupus anticoagulant
+ve VDRL (fals positive)
normal PT, prolonged aptt
thrombocytopaenia
what is the mechanism of tranexamic acid
antifibrinolytic. competitive inhibitor to the enzyme converting plasminogen to plasmin
retinitis pigmentosa
characterised by gradual loss of night and peripheral vision. pigmented bone-spicules in the mid periphery
central retinal VEIN occlusion vs central retinal ARTERY occlusion
BOTH: sudden, painless loss of vision in one eye
VEIN: torturous veins, retinal haemorrhages in all 4 quadrants of the eye
ARTERY: pale retina due to iscahemia, cherry red spot on the macula
which murmur is diminished in pregnant women?
aortic regurg, due to decrease in diastolic pressure, therefore difference in aortic and LV pressure is lower
management of choice for torsades de pointes
magnesium
character of pulse in PDA?
collapsing
ddx of acute pulm oedema
severe LVD, paroxysmal arrhythmias, 3 vessel or left mainstem coronary artery disease
skin signs associated with type iii hyperlipoproteinamia
palmar xanthomata and tuboeruptive xanthomata
skin sign associated with type ii hyperlipoproteinamia
xanthoma tendinosum
which hyperlipoproteinamia is associated with glucose intolerance and hyperuricaemia
type v
what are some of the complications of type i hyperlipoproteinamia
occlusion of retinal vein, acute pancreatitis, steatosis, organomegaly and lipaemia retinalis
systolic-click murmur syndrome
mid-systolic mitral valve prolapse with recurrent non-coronary artery chest pains –> leads to excessive stress on the heart and ischaemia. The systolic click improves with standing
what ecg changes may be seen in patients with aortic dissection?
st changes in inferior leads (ii iii avf) as a backward tear can disrupt flow in the RCA
causes of a split second heart sound
ASD, right heart failure, pulmonary hypertension
what is the criteria for thrombolysis for coronary events
1mm st elevation in limb leads or 2mm elevation in chest leads….within 2? 3? hours
