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MRCP 2 > Neuro, rheum, theaputics > Flashcards

Neuro, rheum, theaputics Flashcards

1
Q

Mixed UMN/LMN signs, wasting of muscles, sensation intact, mild frontotemporal dementia Sx=? dx?

A

MND
Nerve conduction studies and electromyography

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2
Q

Adult, muscle weakness, cataracts and ptosis =

A

myotonic dystophy

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3
Q

Symptoms of subacute degeneration of spinal cord

A

Ataxia
Loss of proprioception
Spasticity
Reduced reflexes

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4
Q

What type of Ca channel to CCBs affect

A

L type channel

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5
Q

Myoclonus elicited by a statle should make you think of a

A

mitochondrial disorder

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6
Q

Lidocaine toxicity presentation

A

Perioral parasthesia first

SAMS
Slurred speech
Altered mental status
Muscle twitching
Seizures

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7
Q

Long-standing Rheum A
Now diarrhoea, weight loss, plaques in the axilla, proteinuria, hepatosplenomegaly =? Dx?

A

AA Amyloidosis
Rectal biopsy

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8
Q

60M Progressive dementia over 3 months with prodromal insomnia and depression = ? ix?

A

Sporadic CJD
Electroencephalography - EEG

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9
Q

Differentiate sporadic and variant CJD on MRI

A

Sporadic - changes in putamen, cordate and cortex

Variant - pulvinar

variant pulverised

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10
Q

Brittle asthma now acutely painful hip and unable to weight bare = ? ix?

A

AVN - needs MRI
[Steroid use]

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11
Q

T score for osteoperosis? When is it different?

A

-2.5
-1.5 if on steroid therapy -> start bisphosphonates

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12
Q

Heavy lifting - now pain over greater tuberosity of shoulder and painful arc on abduction =

A

supraspinatus

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13
Q

IV nitroprusside, now SOB abdo pain widespread ST depression = ? rx?

A

Cyanide poisoning from nitroprusside

IV dicobalt edetate

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14
Q

bodybuilder taking steroids hormones?

A

Raised testosterone
reduced LH (negative feedback from testosterone)

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15
Q

Pure motor or sensory stroke is?

A

Lacunar

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16
Q

TACS, PACS and lacunar stroke

A

TACS - Cerebral dysfunction, sensory, motor and visual

PACS - 2 of the 3 above

Lacunar - 1

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17
Q

Exercise then a few hours after weakness =

A

hypokalemic periodic paralysis

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18
Q
A

Meningioma of the cerebellar pontine angle

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19
Q

2 options for rx of acute dystonic reaction

A

Procyclidine
trihexyphenidyl hydrochloride

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20
Q

6-MP What drug can be fatal if co-administered

A

Allopurinol

[Prevents degradation of 6-MP

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21
Q

Severe headache
hypotension
Low Na raised K
Meningisim, CN VI palsy, visual field defect

A

Pituitary apoplexy
with compression of optic chiasm

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22
Q

Raynauds on atenolol for BP with creat 180. what should you do

A

Stop atenolol - worsens Raynaud’s
Start ramipril for renoprotection

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23
Q

avPu, haemodynamically stable
Digoxin overdose what can be given other than fab frgaments?

A

phenytoin
[plus IV digibind (fab fragments)]

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24
Q

Rheum DMARDs safeish in preg

A

Azathioprine, sulfasalazine and hydroxycloroquine

ASH is alright this time

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25
Q

28F, Myasthenia, 6 weeks worsening sx with weight gain and ankle oedema

A

Pregnant - causes MG flares in first trimester

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26
Q

Hx gout new diagnosis UC. Plan to start azathioprine. What do you need to do?

A

Stop allopurinol
check TPMT

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27
Q

Why do steroids cause bone fractures?

A

Alter PTH secretion

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28
Q

Stenosis of carotid for endarctectomy

A

> 50%
ONLY internal carotids

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29
Q

Brain surgery as a kid
Now depression -> cognitive impairment and myoclonic jerks

A

CJD

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30
Q

When is schirmers test positive

A

<5mm wetting after 5 minutes

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31
Q

Infection / surgery
-> very painful arm followed by proximal weakness and some sensory changes especially axillary

A

Brachial neuritis

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32
Q

Which DMARD may cause weakness, difficulty swallowing and a myasthenic picture

A

Penicillamine

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33
Q

Swollen knee
polarised light of aspirate - needle-shaped

A

Gout

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34
Q

Rheum A, has paraesthesia of lateral 2 fingers =- key iX?

A

Carpal tunnel
EMG / nerve conduction studies

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35
Q

On warfarin and given drug for fungus that inhibits mititic spindle of fungus - what happens to inr

A

Decreases - drug is Griseofulvin

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36
Q

Sudden visual loss affecting eye. Cotton wool spots and flame haeemorrhages in 1 quadrant. Prolonged APTT

A

BRVO - due to Antiphospholipid syndrome

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37
Q

Young onset ischemic event needs to check what

A

cocaine use

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38
Q

Rivaroxaban which factor inhibited

A

10a

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39
Q

Heparin affects

A

Antithrombin III

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40
Q

MG crisis of weekness unable to swallow needs

A

IV Ig

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41
Q

Most common side effect of donepezil / ACH inhib

A

insomnia
anorexia, hallucinations, aggitation

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42
Q

sCJD in 50s what ix first?

A

MRI
Then LP for protein 14-3-3

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43
Q

20s resting tremor and raised transaminases

A

Wilsons

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44
Q

Polymyalgia key iX

A

ESR

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45
Q

Dry red patches that became scaly. Areas of hair loss. worse in summer

A

Discoid lupus

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46
Q

Intention myoclonus following cerebral hypoxia eg OOHCA

A

lance adams syndrome

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47
Q

Weakness of finger flexors and quadriceps with mild rise in CK

A

Inclusion body myositis

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48
Q

Sensory loss over middle fingers of hand

A

T7

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49
Q

Most specific test for sCJD

A

Real time quaking induced conversion test
RTQuICT

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50
Q

BIG pile of aspirin 30 mins ago

A

gastric lavage

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51
Q

Excercise induced muscle pain and dark urine? ix?

A

McArdle sydrome [muscle phosphylase deficiency]

Serum lactate following exercise

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52
Q

Confirmed xanthochromia on LP with normal CT. What next

A

MRA

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53
Q

Cluster heache but actually 30 episodes per day and in a woman = rx?

A

Paroyxsmal hemicrania

Indomethcin

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54
Q

S

A
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55
Q

Neuroleptic malignant syndrome Rx

A

Bromocriptine

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56
Q

Causes of chronic urticaria

A

Asprin
NSAIDs
Opiates

57
Q

Cholinesterase inhibitor toxicity 2 parts Rx

A

Atropine
Pralidoxime

58
Q

5/12 of TB rx. now photosensitive ras on face rx?

A

Has Drug-induced lupus
Stop all meds and monitor

59
Q

CO posioning 1st line Rx

A

Non rebreath 100% O2

60
Q

Toxic alcohol 1st drug

A

Fomepizole

61
Q

Fatty with heachache and CN6 palsy
Normal CT
LP raised pressure
Plan?

A

CT Venography
-Need to exclude thrombus

[IIH is a diagnosis of exclusion]

62
Q

How to excrete in urine more aspirin in overdose

A

Sodium bicarb

63
Q

Stange cause of IIH

A

Vit A excess

64
Q

Antidepressant choice if pt on warfarin, aspirin or heparin to avoid increased bleeding risk

A

Mirtazapine

65
Q

How to test for testosterone doping

A

Urinary testosterone:epitesosterone ratio

66
Q

Liver transplant ref criteria

A

ph <7.3 or lactate >3 after fluid

within 24hrs
-Cr >300
-PT >100s or INR >6.5
-Grade III/IV encephalopathy

67
Q

Nodules on hand with DIP joint space erosions

A

multicentric reticulohistocytosis

68
Q

Monitoring pagets

A

6 monthly ALP

69
Q

AntiGBM rx

A

plasma exchange + steroids
[not cyclophosphamide]

70
Q

photosensitivity after recent admission with AF

A

amiodarone

71
Q

Rheum arthritis and develops this -
Which drug makes it worse? better?

A

MTX - worse
Rituxumab - better

72
Q

HTN comes in with reduced GCS and hypoglycaemia

A

Bb overdose
Glucagon

73
Q

Bilateral haemangiomas and left flank mass

A

VHL

74
Q

Dermatomyositis high or low dose pred

A

Higjh

75
Q

Diagnostic criteria for diabetic nephropathy

A

GFR <60 for 3 months
Urine ACR >3mmol/L for 3 months

76
Q

Old houses, anaemia, neuropathy and ckd
rx?

A

lead poisoning

Any of:
Penicillamine
DMSA
calcium disodium

77
Q

Best imaging for pagets

A

Skeletal survey

[Not isotope bone scan]

78
Q

1st line pyelonephritis oral

A

Cefalexin

79
Q

Teenager with fam Hx of PKD normal US
When re scan

A

when they are 20

80
Q

Which farm thing if hypersalivation, constricted pupils, sweating

A

Organophosphate insecticides
[cholinergic intoxication]

81
Q

Most effective antipsychotic for parkinsons psychosis

A

Clozapine

82
Q

Dark urine with pigmentation of ears and sclera
Joint pain

A

Alkaptonuria

83
Q

SAH and hypertension 1st line

A

Labetalol

84
Q

Which juice worst for wafarin

A

Cranberry

[not grapefruit]

85
Q

What National insititute of health stroke scale NIHSS has a 50% risk of haemorrhagic transformation

A

> 15

86
Q
A

Gottrons papules

87
Q

Cyanide poisoning rx

A

dicobalt edetate

88
Q

PFO with TIAs rx

A

Closure of PFO

89
Q

what is the trio of miller fisher

A

Ophthalmoplegia
Ataxia
Areflexia

90
Q

which diretics -> gout

A

Thiazides -> reduce renal uric acid excretion

91
Q

weakness of what causes winging of the scapular

A

serratus anterior

92
Q

where are the red macules and papules in fabry

A

peri umbilical

93
Q

RTA and now dizziness when moves head

A

BPPV

94
Q

Sclerosis sx positive anti centromere why SOBOE

A

Pulmonary artery HTN

[Fibrosis if positive anti-topoisomerase]

95
Q

30 with some ataxia then sudden deterioration CT demonstrates hydrocephalus?

A

haemangioblastoma in cerebellum

96
Q

Dermatomes c5-t1

A

Dermatome C7 extends to the middle finger and divides dermatomes C5 and C6 (lateral) from C8 through T1 (medial).

C5: lateral aspect of arm
C6: lateral aspect of forearm and hand
C7: middle finger and ray
C8: medial aspect of hand
T1: medial aspect of forearm

97
Q

Dermatomes L2-S5

A

2, 3, 4, 5, stand on S1, lie on S2, sit on S3, wipe S4/S5

Slap thigh lateral then medial: L2 then L3
Slap lower legs medial then lateral: L4 then L5
Stand on sole of foot: S1
Lie on back of thigh and calf: S2
Sit on buttocks: S3
Wipe perianal area: S4, S5

98
Q

Why hyperGycaemia with steroids

A

increased glucomeogenesis

99
Q

Diabetes old shoulder injury now swelling and loss of function

A

Charcot joint

100
Q

Want to make a Dx of common peroneal palsy

A

nerve conduction studies

101
Q

Night blindness and sensorineural deafness =? ix?

A

Refsum disease

phytanic acid levels

102
Q

On carbamazepine and wants to start COCP

A

Higher dose of COCP as carbamazepine is a liver inducer

103
Q

PCI on Aspriin fonda and clopi then has a UGI bleed which shouldd you stop

A

Fonda only at first
[aspirin and clopi to stop stent thrombosis]

104
Q

Farmer spraying crops now dowsy, profuse sweating and salivation rx?

A

Wash contaminated areas
Atropine + pralidoxime
]May need ventilation if no response]

105
Q

Atery for parietal lobe

A

MCA

106
Q

Confirm lambert eaton syndrome

A

EMG + nerve condiction

107
Q

Key finding to differentiate fredricks and Charcot marine tooth

A

Only fredricks has dysarthria

108
Q

Diarrhoea, myalgia, anterior uveitis and superficial thrombophlebitis

A

Bechets

109
Q

Patches of hairloss with scaring and plaques behind ears / cheeks

A

discoid lupus

110
Q

Gynecomastia medications

A

DISCO MTV

Digoxin
Isoniazid
Spironolactone
Cimetidine
Oestrogen

111
Q

3 weeks fevers, oligoarthritis, and pericarditis

A

Adult onset juvenile chronic arthritis

112
Q

T2DM, hypercholesterol and long standing pain and swelling

A

Gout

113
Q

Unilateral parkinsonism with apraxia and ‘alien limb’

A

Corticobasal syndrome

114
Q

Gym goer gets sick and needs intubated then recovers after 3 hrs

A

Gamma-hydroxybutyrate overdose

115
Q

Cluster headache prevention

A

Verapamil

116
Q

Bechets with DVT rx

A

Pred + azithro/cyclo/ciclo

117
Q

What does osteomalacia look like on xray

A

Low density bands extending from the cortex

118
Q

Wrist and ankle swelling with pustular lesions. Aspirate demonstrates lots of white cells

A

Gonococcal

119
Q

Poor conrolled diabetes

A

cerebral abscess

120
Q

Weakness, sensory ipsilateral sx and headache ix?

A

MRI brain

121
Q

Homeless with HAGMA and blurred vision

A

Methanol poisioning

122
Q

Amiodarone develops thyrotoxicosis with positive thyroid antibodies and multinodular goitre ? rx?

A

Amiodarone TYPE 1
Antithyroid drugs

123
Q

Test for EPO abuse

A

Urine

124
Q

Compression fracture of L4 in 74F. rx?

A

bisphosphonates§

125
Q

Weepy unilateral reaction affecting 1 nipple rx?

A

Likely Padgets -> refer breast clinic

126
Q

Left sided TIAs with 100% occlusion Right carotid rx?

A

Clopi
[complete occlusion is a CI to endarctectomy

127
Q

Key ix for vertebral artery dissection

A

MRA

128
Q

Frontal balding, myotonia, cataracts, wasting of sternocleidomastoid, dysphagia and general muscle weakness =? ix?

A

Myotonic dystrophy

EMG
[not biopsy]

129
Q

Quads and forearm weakness

A

Inclusion body myositis

130
Q

Pre eclampsia how to redue BP

A

Labetalol
[Mg is for seizure prevention]

131
Q

2 key antiemetics in preg

A

Cyclizine
promethazine

132
Q

sclerosis which antibodies highest risk for renal crisis

A

Anti RNA polymerase III

133
Q

Amlodipine overdose rx?

A

Calcium chloride ….CCBs

134
Q

TB rx develops this rash due to?

A

Isoniazid - drug-induced lupus

135
Q

Better than beta interferon for MS relapse prevention

A

fingolimod

136
Q

myasthenia best Ix

A

EMG

137
Q

Painful swolllen joints Rx?

A

MTX + steroids

138
Q

hypertensive stroke target systolic bp

A

140mmHg

MRCP 2 (5 decks)

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