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MRCP > Passmed deck 1 > Flashcards

Passmed deck 1 Flashcards

1
Q

What is the inheritance of most eye disorders

A

X-linked recessive

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2
Q

What do T-Helper cells excete

A

IL4, IL5, IL6, IL10 and IL13

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3
Q

What prodces TNF-Alpha

A

Monocytes and macropahges

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4
Q

Describe X-linked inheritance

A

Passed on from mum NOT dad
ALL female children from affected fathers are carriers
(girls always carry dads x chromosome)

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5
Q

What secondary messnager does nitric oxide stimulat

A

Cyclic GMP

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6
Q

How to work out number needed to treat (NNT)

A

NNT = 1 / Absolute Risk Reduction

e.g -
Control event rate = 4% = 0.04
Experimental event rate = 2% = 0.02

Absolute risk reduction = 0.04 - 0.02 = 0.02
Number needed to treat = 1 / 0.02 = 50

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7
Q

How to work out positive predictive value

A

Positive predictive value = TP / (TP + FP)

TP - True positive
FP - False positive

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8
Q

What % is 1 standard deviation

A

68.3%

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9
Q

What is dry deriberi

A

Disease caused by B1 deficency (thiamine) -
Get peripheral neuropathy

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10
Q

What is wet beriberi

A

Thiamine deficency that causes heart failure

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11
Q

Give the timeline of alcohol withdrawal

A

symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours

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12
Q

What chromosome is the alpha-globulin genes located on?

A

16

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13
Q

What is the main action of atrial natriuretic peptide?

A

Atrial natriuretic peptide - powerful vasodilator

Also inhibits RAAS system

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14
Q

How to remember what parts of the adrenal cortex excrete what

A

Adrenal cortex mnemonic: GFR - ACD (DHEA)

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15
Q

Where does glucose and reabsorption occur in kidneys

A

Proximal convoluted tubule

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16
Q

What defect occurs in fanconi syndrome

A

Proximal convoluted tubule defect - get low PO and glucose as absorbed here but high glucose and protein output

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17
Q

Best test for detecting and quantifying viral protein

A

Western blotting

PCR amplifies it so cannot quantify. Also looks at DNA not proteins so can suggest X disease is present

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18
Q

How to calculate odds ratio

A

Odds of a golfer developing medial epicondylitis = 30 / 30 = 1. If we were calculating the risk, rather than the odds that is asked for, it would be 30 / 60 = 0.5.

Odds a non-golfer developing medial epicondylitis = 10 / 50 = 0.2. Again, the risk would be 10/60 = 0.16.

The odds ratio is therefore = 1 / 0.2 = 5

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19
Q

What cell surface proteins are characteristic of reed sternberg cells?

A

C15

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20
Q

How to identify a gliobastoma multiforme on imaging and histology

A

On imaging they are solid tumours with central necrosis and a rim that enhances with contrast. Disruption of the blood-brain barrier and therefore are associated with vasogenic oedema.

  • Histology: Pleomorphic tumour cells border necrotic areas
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21
Q

What infections are people with T cell dysfunction at risk of

A

Fungal

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22
Q

Give 4 tests used to test significance on non-parametric data

A

Chi squared
Spearmans rank correlation coefficient
Wilcoxon matched pairs
Mann Whitney

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23
Q

If distribution is normal what does that mean for the mode median and mean

A

Mean = mode = median

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24
Q

What is Li-Fraumeni syndrome

A

Disease caused by a p53 mutation which is associated with early onsent breast cancer, sarcoma and leukaemia

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25
Q

What type of cancers are associated with gorlin syndrome

A

Basal cell cancers and medulloblastomas

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26
Q

What is von hippel lindau syndrome

A

Von Hippel-Lindau syndrome is an autosomal dominant condition characterised by haemangioblastomas, renal cysts and renal cell carcinoma, pancreatic neuroendocrine tumours, pheochromocytoma

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27
Q

What cells make IgE

A

Plasma cells

Mast cells is incorrect, as these cells degranulate in response to the engagement of their surface-bound IgE with antigen, rather than produce IgE itself.

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28
Q

When are eosinophils raised

A

Parasitic infections

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29
Q

What supplement, other than iron, is good for iron deficiency anaemia

A

Vitamin C (ascorbic acid) supplementation can aid iron absorption from the gut by conversion of Fe3+ to Fe2+

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30
Q

Why is vitamin C good to give for iron deficiency

A

Iron is best absorbed in the small intestine in the ferrous form (Fe2+). Ferric iron (Fe3+), however, is more difficult for the intestinal mucosa to absorb. By the addition of Ascorbic acid (vitamin C) to oral iron therapy, there is increased conversion of Fe3+ to Fe2+ in the gastrointestinal tract. This increases the proportion of Fe2+ iron, which is more readily absorbed, thus improving the response to treatment.

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31
Q

How to calculate relative risk reduction

A

Relative risk reduction = (EER - CER) / CER

Experimental event rate, EER = 15 / 150 = 0.1

Control event rate, CER = 100 / 250 = 0.4

Relative risk reduction = (EER - CER) / CER = (0.1 - 0.4) / 0.4 = -0.75 or a 75% reduction

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32
Q

Give two parametric tests (non-dichomatous data) for significance testing

A

Student’s t-test - paired or unpaired*
Pearson’s product-moment coefficient - correlation

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33
Q

Give 4 non-paramatric tests (dichromatous data)

A

Mann whitney test
Wilcoxon signed rank test
Chi squared test
Spearman kendall rank

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34
Q

When is a mann whitney U test used

A

compares ordinal, interval, or ratio scales of unpaired data

Non-parametric only

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35
Q

When is a wilcoxon signed-rank test used

A

compares two sets of observations on a single sample, e.g. a ‘before’ and ‘after’ test on the same population following an intervention

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36
Q

When is a chi-squared test used

A

used to compare proportions or percentages e.g. compares the percentage of patients who improved following two different interventions

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37
Q

What is the main role of the golgi apparatus and give an example

A

modify molecules and prepare them either for secretion or lysosomal breakdown.

e.g. - Golgi adds mannose-6-phosphate to proteins for trafficking to lysosomes

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38
Q

What is the role of the rough endoplasmic reticulum

A

Translation and folding of new proteins
Makes lysosomal enzymes

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39
Q

What is the role of the smooth endoplasmic reticulum

A

Steroid and lipid synthesis

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40
Q
A
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41
Q

What is the role of the mitochondria

A

Aerobic respiration and mitochondrial DNA genome

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42
Q

What is the role of the nucleus

A

DNA maintenance
RNA transcription
RNA splicing

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43
Q

What is the role of the ribosome

A

Translation of RNA to proteins

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44
Q

What is the role of the nucleolus

A

Ribosome production

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45
Q

What is the role of the peroxisome

A

Catabolism of very long chain fatty acids and amino acids
Results in the formation of hydrogen peroxide

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46
Q

What is the role of the protesasome

A

Degredation of proteins that are tagged with ubiquitin

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47
Q

What is the best scan for cerebral mets

A

Contrast MRI scan

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48
Q

What receptors does insulin bind to

A

Insulin binds to a receptor tyrosine kinase in the cell membrane

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49
Q

What are ligand-gated ion channel receptors used for

A

mediate fast responses such as nicotinic acetylcholine.

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50
Q

What are G protein-coupled receptors used for

A

mediate slow transmission and affect metabolic processes

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51
Q

How to calculate specificity

A

Specificity = TN / (TN + FP)

TN - True negative
FP - False positive

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52
Q

Treatment for homocystinuria and what is it

A

Pyridoxine.

Homocystinuria is an autosomal recessive disorder characterized by the deficiency of the enzyme cystathionine beta-synthase, which uses vitamin B6 (pyridoxine) as a cofactor.
Pyridoxine reduces homocystine levels.

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53
Q

How to work out down syndrome risk for age

A

Down’s syndrome risk - 1/1,000 at 30 years then divide by 3 for every 5 years

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54
Q

What is the treatment for cocaine induced ACS

A

Lorazepam - helps control BP and HR

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55
Q

What drug class is flecanide and how is it administered

A

Sodium channel blocker - Class 1 agents

Used either every day or PRN with patient gets AF episode

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56
Q

When is amiodarone used for AF and what drug class is it

A

Class III - K channel blocker

Used for acute AF

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57
Q

When is digoxin used for AF and what drug class is it

A

Used in cardiac failure for AF

It is a sodium-potassium adenosine triphosphatase channel inhibitor

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58
Q

What is the treatment for ethylene glycol (antifreeze) toxicity

How does toxicity present

A

Fomepizole

Ethanol is second line - outcompetes antifreeze for alcohol dehydrogenase thus stopping its breakdown and damaging liver.

Like being drunk - slurred speech and dizziness, tachy and AKI and metabolic acidosis

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59
Q

What drugs are affected by a patients acetylator status (how quickly a person metabolises a drug)

A

SHIP -

Sulphonamides
Hydralazine
Isoniazid
Procainamide

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60
Q

What electrolyte imbalance is associated with MDMA

A

Hyponatraemia

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61
Q

Adverse effects of quinolones (Ciprofloxacin and levofloxacin)

A

Lower seizure threshold
Tendon damage
Prolonged QT

Cannot have if G6PD or pregnant/breastfeeding

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62
Q

How does quinine toxicity present

A

ECG changes (QRS widening, prolonged PR and QT), Hypotension, metabolic acidosis, hypoglycaemia, tinnitus, visual disturbances

Severe - flash pulmonary oedema

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63
Q

Treatment for adrenaline induced ischaemia

A

Phentolamine - alpha receptor blocker

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64
Q

Therapeutic drug monitoring times for digoxin, lithium, ciclosporin, phenytoin

A

“I have a DATE @ 6, So I will be LATE @ 12. Text before you CHECK on me & PHONE if you have Doubt”.

Digoxin - 6hrs
Lithium - 12hrs
Ciclosporin - immediately before dose
Phenytoin - dont need to check unless worry of toxicity or change in dose

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65
Q

Examples of tyrosine kinase receptors

A

Growth factor
Insulin
Cytokines

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66
Q

Common ion channel receptor

A

GABA

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67
Q

What is caustic (corrosive) ingestion and how is it managed

A

ABCDE
CXR for surgical emphysema
Urgent upper GI referral
Neutralisation avoided aka give acid (causes exothermic reaction)
Give high dose PPI IV
Urgent endoscopy in 24hrs (pain, drooling, vomiting)

If asymptomatic - observe and oral fluid

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68
Q

Drugs that can worsen lithium toxicity (DR DAMAN)

A

Dehydration
Renal failure

Diuretics
ACEIs
Metronidazole
ARBs
NSAID

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69
Q

What time of drug is rituximab

A

CD20 inhibitor - used in hogkins lymphoma

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70
Q

What type of drug is infliximab

A

TNF-alpha inhibitor used in crohns

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71
Q

What type of drug is daratumumab

A

Acts on CD38 - multiple myeloma

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72
Q

How does alemtuzumab work

A

CD52 - used in chrinic lymphocytic leukaemia

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73
Q

How does trastuzumab work

A

HER2 antagonist - used in metastatic breast Ca

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74
Q

What happens to to oxygenation dissociation curve in carbon minoxide poisoning

A

Shift left and downwards

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75
Q

What drug is contraindicated for fast AF in structural heart disease, ischaemic heart disease and chronic heart filaure

A

Flecainide - increased risk of arrhythmia and mortality

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76
Q

When to give amitrytiline OD treatment

A

If widened QRS or arrhythmia

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77
Q

What antibiotics are folate inhibitors

A

TrimeFOprim
SulFOnamides

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78
Q

What antibiotics cause DNA damage to bacteria

A

MetroniDNAzole

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79
Q

Which antibiotics attack 30s protein subunit on bacteria

A

I AM 30(s) which is Terrifying - 30s (protein) subunit -

AMinoglycosides, TEtracyclines

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80
Q

Which antibiotics inhibit peptiglycan synthesis

A

Vancomycin
Teicoplanin - longer half life

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81
Q

Which antibiotics inhibit Peptigoglycan cross linking

A

Penicillins, cephlasporins and carbepenmas

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82
Q

What antibiotics are DNA topoisomerases

A

They untangle DNA - Quinolones (cipro-floxaicin)

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83
Q

How does NAC work

A

Glutathione precursor to replenish stores to conjugate the active metabolite

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84
Q

What biochemical changes does adrenaline induce

A

Adrenaline induces hyperglycemia, hyperlactatemia and hypokalaemia
Adrenaline also raises lactate due to increased oxygen consumption

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85
Q

How does tacrolimus work

A

Decreases IL2 - inhibits calcineurin

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86
Q

How does mercury poisoning present

A

Mercury poisoning can cause visual field defects, hearing loss and paraesthesia

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87
Q

What does amiodarone do to the thyroid gland

A

Can induce hypothyrodism due to high iodine

Can also induce hyperthyroidism due to excess ioidine or distructive thyroiditis
- if goitre - carbimazole
- if no goitre - corticosteroids

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88
Q

How do thiazolidinediones

A

Thiazolidinediones (or ‘glitazones’) bind to peroxisome proliferator-activated receptor-gamma in adipocytes to promote adipogenesis and fatty acid uptake (in peripheral but not visceral fat).

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89
Q

How do DPP4 inhibitors work

A

DPP-4 inhibitors work by blocking the action of DPP-4, an enzyme that destroys the hormone incretin. Incretin helps the body produce more insulin only when it is needed and reduce the amount of glucose being produced by the liver when it is not needed.

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90
Q

What do alpha 1 receptors do

A

vasoconstriction
relaxation of GI smooth muscle
salivary secretion
hepatic glycogenolysis

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91
Q

What do alpha 2 receptors do

A

mainly presynaptic: inhibition of transmitter release (inc NA, Ach from autonomic nerves)
inhibits insulin
platelet aggregation

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92
Q

What do beta 1 receptors do

A

mainly located in the heart
increase heart rate + force

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93
Q

What do beta 2 receptors do

A

vasodilation
bronchodilation
relaxation of GI smooth muscle

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94
Q

What do beta 3 receptors do

A

lipolysis

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95
Q

Most effective anti-emetic for motion sickness

A

Hyoscine then cyclizine

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96
Q

Treatment for oculogyric crisis

A

Procyclidine

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97
Q

What are the defining characteristics of all 4 times of renal tubular acidosis

A

Type 1 - distal CT. Causes stones and caused by rheumatoid conditions.

Type 2 - proximal CT. Causes osteomalacis. Caused by drugs and fanconi syndrome + wilsons disease

Type 3 - Mixed. Rare, carbonic anhdrase II deficiency.

Type 4 - Hyperkalaemic. Diabetes and hypoaldosteronism.

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98
Q

Major differences between erythema nodosum and pyoderma gangrenosum

A

Erythema nodosum causes multiple tender, erythematous, nodular lesions (does not ulcerate)

Pyoderma gangrenosum is often a single ulcerating painful lesion

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99
Q

Treatment for idiopathic thrombocytopenic papura

A

Oral prednisalone

Give IV immunoglobulins as second line or if severe bleeding

Platelet transfusions do little as it is immune mediated platlet distruction

Observe if platelets >30

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100
Q

Investigations needed for idiopathic thrombocytopenic papura

A

Hep B, C, HIV, U+Es, clotting screen, FBC, Pregnancy test, blood smear

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101
Q

DVLA rules for epilepsy

A

1st seizure - no Ix abnormalities: 6 months
1st seizure - imaging/EEG abnormal: 12 months
Epilepsy / multiple seizures: can drive if seizure free 1 year, if 5 years free - til 70 licence
Withdrawal of meds: 6 months after last dose

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102
Q

DVLA rules for syncope

A

Simple faint: no restriction
1 episode, explained, treated: 4 weeks
Single episode, unexplained: 6 months
2 or more episodes: 1 year

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103
Q

Stroke/TIA DVLA rules

A

1 month

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104
Q

Chronic muscular condition DVLA rules

A

Inform and PK1 form

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105
Q

Nacrolepsy and cataplexy dvla rules

A

Until symptoms controlled.

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106
Q

Thread worms are the commonest cause of perianal itching in children what is their medical name?

A

Enterobius vermicularis

Treat with mebendazole

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107
Q

Two observations to monitor with IV mg

A

Reflexes and RR

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108
Q

Commonest cause of wide pulse pressure

A

Reduced aortic compliance - each ventricular ejection leads to a greater increase in systolic blood pressure, while the diastolic blood pressure decreases due to increased vascular resistance, leading to increased pulse pressure.

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109
Q

What is Miller Fisher syndrome

A

GBS subtype characteristed by a classic triad of symptoms: ophthalmoplegia, ataxia, and areflexia.

110
Q

Causes of RAPD

A

Optic neuritis
Retinal detachment

111
Q

What is brodman area 22 in the superior temporal gyrus

A

Wernickes

112
Q

Where is brocas area

A

Inferior frontal gyrus

113
Q

What drug should not be given in those with VT

A

Verapamil as can cause VF

114
Q

What hormone change causes ovulation

A

LH surge

115
Q

What hormonal changes happen during the follicular (proliferation phase) and the luteal (secretory phase)

A

Follicular - A rise in FSH results in the development of follicles which in turn secrete oestradiol

When the egg has matured, it secretes enough oestradiol to trigger the acute release of LH. This in turn leads to ovulation

Luteal - Progesterone secreted by corpus luteum rises through the luteal phase.

If fertilisation does not occur the corpus luteum will degenerate and progesterone levels fall

Oestradiol levels also rise again during the luteal phase

116
Q

How does tetanus work (clostridium tetani)

A

This bacteria releases the tetanus toxin (tetanospasmin) which blocks the release of the inhibitory neurotransmitters GABA and glycine resulting in continuous motor neuron activity. This continuous muscle contraction results in spastic paralysis, lockjaw and eventual respiratory paralysis.

117
Q

How to determine the 5 main causes of melanoma

A

Lentigo malinga - usually from a freckle with suspicious features

Superficial spreading - commonest and usually younger people

Acral lentiginous - nails or palms/soles

Desmoplastic melanoma - nerves

Nodular - nodules and oozes

118
Q

Treatment for diarrhoea post-op in crohns resection with no infective features

A

Cholestryamine - usually due to bile acid malabsorpation.

Should be 95% reabsorbed by terminal ileum but if not there then will get dairrhoea via osmosis and gut motility

119
Q

What is a conversion disorder

A

Functional neurological disorder (conversion disorder) - typically involves loss of motor or sensory function

120
Q

What is somatisation disorder

A

multiple bodily complaints lasting months to years and persistent anxiety about their symptoms.

121
Q

How does oseltamivir work

A

Is a neuraMInidase inhibitor

122
Q

What outcome is measured for cohort studies

A

Relative risk

123
Q

What outcome is measured for case-control studies

A

Odds ratio

124
Q

How to tell difference between hepatitis A and hepatiits E from hx

A

A - shellfish
E - pork

125
Q

What is gitelmans syndrome and name the triad of features associated with it

A

Gitelman’s syndrome is a renal tubular disorder characterised by normotension, hypokalaemia + hypocalciuria

126
Q

Features of Von Hippel-Lindau disease

A

faulty tumour suppressor gene resulting in the development of multiple unusual tumours including haemangioblastoma, phaeochromocytoma or renal cell carcinoma.

127
Q

Features of Peutz Jeghers syndrome

A

disorder causing large numbers of polyps in the intestine which become cancerous in a majority of patients. They have pigmented lesions around the lips

128
Q

Electrolyte differences between tumour lysis syndrome and refeeding syndrome

A

TLS - hyperkalaemia, hyperphosphataemia, and hypocalcemia

RFS - hypophosphataemia, hypokalaemia and hypomagnesaemia

129
Q

Features of refeeding syndrome

A

Think of it as phosphate is key for ATP so lack of energy for all major body functions -

Rhabdo - due to low phosphate
Resp failure - due to low phosphate
Cardiac failure - due to low phosphate

130
Q

First line treatment for acute angle-closure glaucoma

A

IV acetazolamide and topical pilocarpine drops

131
Q

What causes retroperitoneal fibrosis and how does it present

A

Lower back/flank pain and occasional fever and lower limb oedema.

Causes - riedels thyroiditis, previous radiotherapy. sarcoidosis, inflammatory AAA, Methysergide

132
Q

What is sturge-weber syndrome

A

Developmental delay, port wine stains, glaucoma, seizures, retinoblastoma

133
Q

What is anti-hu antibodies associated with

A

Sensory neuropathy and cerebellar syndrome - get it with SCLC and neuroblastoma

134
Q

What is anti-GAD antibodies associated with

A

Breast, colorectal or SCLC

Get widespread hypertonia

134
Q

What is anti-Yo antibodies associated with

A

Cerebellar syndrome - ovarian or breast

135
Q

What is anti-Ri antibodies associated with

A

Associated with breast and SCLC

Ocular opsoclonus myoclonus

136
Q

When and how to treat gestational diabetes

A

ONLY look at fasting BM -

<7 but higher than 5.4 then diet, metformin then insulin

> 7 then insulin asap

137
Q

Sick euythoid syndrome bloods

A

(TSH, thyroxine and T3) is low. In the majority of cases however the TSH level is within the >normal range (inappropriately normal given the low thyroxine and T3).

138
Q

What is the pathophysiology of methaemoglobaemia

A

Oxidation of Fe2 to F3 cant happen

139
Q

What are the gold standard Ix for the 4 main haematological cancers? (ALL, AML, CLL, CML)

A

ALL- bone marrow biopsy
AML - bone marrow biopsy (look for myeloblasts)
CLL - flow cytometry/immunophenotyping
CML - FISH/PCR to look for BCR-ABL gene

140
Q

What type of cancer has a T 11 - 14 translocation

A

Mantle cell lymphoma

141
Q

Minimal change disease rx

A

Watch and wait or pred if severe

142
Q

Why does addisons cause axillary hair thinning in females

A

Thinning of pubic and axillary hair is seen in females with Addison’s disease due to reduced production of testosterones from the adrenal gland

143
Q

How does a villous adenoma present

A

Secrete a large amount of mucus so -

Diarrhoea
Hypokalaemia
Colonic polyps

144
Q

How does Peutz-Jeghers syndrome present

A

autosomal dominant genetic condition

Symptoms usually appear during the first decade of life and begin with spots of dark skin freckling (melanocytic macules) around the mouth, eyes, nostrils, and fingers as well as inside the mouth (oral mucosa) and around the anus (perianal). Multiple benign polyps called hamartomas also begin to grow in the gastrointestinal tract of affected individuals around that age.

145
Q

First, second and third treatment for psoriasis

A

Topical steroid and topical calcipotriol (vit D) to try for 4 weeks

then double vit D to twice daily if no improvement

+ Coal tar is 3rd line

146
Q

What is an acceptable eGFR decrease when starting ACEI

A

a decrease in eGFR of up to 25% or a rise in creatinine of up to 30% is acceptable

147
Q

Commonest and second commonest genetic causes of nephrogenic diabetes insipidus

A

Commons is vasopressin ADH receptor abnormality

Second commonest is mutation in gene for aquaporin 2 channels

148
Q

What DMARD is safe in pregnancy and breastfeeding

A

Sulfasalazine

149
Q

What channel abnormality is associated with prolonged QT

A

Potassium channels

150
Q

Raised anti-phospholipase A2 is seen in what condition

A

Idiopathic memrbanous glomerulonephritis

151
Q

Which antipsychotic is most associated with raised triglycerides

A

Olanzapine

152
Q

What HLA serotype is related to coeliac

A

HLA DQ2

153
Q

What HLA serotype is related to Behcets

A

HLA B51

154
Q

What HLA serotype is related to SLE and addisons

A

HLA DR3

155
Q

What HLA serotype is related to reactive arthiritis

A

HLA B27

156
Q

Ix of choice for cervical myelopathy

A

MRI Cervical spine

157
Q

How does subacute combined degeneartion of the spinal cord present

A

Distal sensory loss, tingling + absent ankle jerks/extensor plantars + gait abnormalities/Romberg’s positive

158
Q

What is important to remember about subacute combined degeneration of the spinal cord in those who take nitrous oxide.

A

B12 level can be falsely normal in those who take a lot of nitrous oxide

159
Q

How does uraemic polyneuropathy present

A

CKD4 or 5 with distal sensory loss ONLY

160
Q

Drug class of ondansetron

A

5HT3 antagonist

161
Q

How does receptive aphasia present (wernickes) and what area of the brain is affected

A

Superior temporal gyrus.

Impaired comprehension and word salad but fluent.

162
Q

How does expressive aphasia present and where is the lesion

A

Inferior frontal gyrus
Sppech is non-fluent, laboured and halting. Repetition is impaired but comprehension is normal.

163
Q

How does conduction aphasia present and where is the lesion

A

Lesion is between wernickes and brocas.
Speech is fluent but repetition is poor. Aware of errors and comprehension is normal

164
Q

How does global aphasia present

A

Large lesion affecting all 3 of the above areas resulting in severe expressive and receptive aphasia

May still be able to communicate using gestures

165
Q

Phenytoin side effects

A

Cerebellar signs
Gum hyperplasia

166
Q

How does juvenile myoclonic epilepsy present

A

classically associated with seizures in the morning/following sleep deprivation in teenage years

167
Q

How does CMV retinitis present

A

white retinal opacities, with haemorrhage, of variable extent and location

168
Q

How to manage right ventricular MI

A

Avoid nitrates
Give slow ivt

Will help preload

169
Q

Commonest endocarditis pathogens

A

Staph aureus
Staph epidermis if <2 months since valve surgery

170
Q

What kind of cancer is associated with hashimotos thyroiditis

A

MALT Lymphoma - usually no B symptoms. Patients are usually in 50s or 60s

171
Q

Factors of metabolic syndrome

A

Need to have 3 of the following -

Reduced HDLs
Raised BP
Enlarge waist circumference
Hypertension
Hyperglycaemia

172
Q

How does orlistat work

A

Pancreatic lipase inhibitor

173
Q

Test order for acroemegaly

A

IGF-1 –> OGTT and serial GH levels –> MRI pituitary

174
Q

Treatment for thyrotoxicosis with tender goitre (subacute (De Quervain’s) thyroiditis)

A

Naproxen

Usually self-limiting after viral illness (raised ESR and TFTs with hyperthyroidism symptoms).

175
Q

What is multifocal atrial tachycardia and how is it managed

A

MAT is irregular cardiac rhythm caused by at least three different sites in the atria, which may be demonstrated by morphologically distinctive P waves. It is more common in elderly patients with chronic lung disease, for example COPD.

Management -
correction of hypoxia and electrolyte disturbances
rate-limiting calcium channel blockers are often used first-line (verapamil/diltiazem)
cardioversion and digoxin are not useful in the management of MAT

176
Q

Common complication of ovarian teratoma

A

Anti-NDMA receptor encephalitis

177
Q

Name the phases of the cell cycle (G0,G1,S,G2,M)

A

G0 - resting phase
G1 - increase in cell size and length (P53)
S - Synthesis of DNA/RNA
G2 - Increase in size
M - Mitosis (cell division and shortest phase)

178
Q

What is mediterranean fever

A

Brucella infection via infected animal products and unpasteurised dairy.

Causes fever, hepatosplenomegaly, OM, sacroililtis

Need brucella serology

Give doxy and streptomycin

179
Q

Features of ebstein anomoly

A

tricuspid regurgitation + pansystolic murmur, worse on inspiration

Can present in adulthood.

180
Q

What is melasma

A

Hyperpigmentated patches ususally on face in pregnancy (caused by increased oestrogen and progesterone)

181
Q

Triangle of safety for chest drains

A

base of the axilla, lateral edge pectoralis major, 5th intercostal space and the anterior border of latissimus dorsi

182
Q

Biggest complication of orbital cellulitis

A

cavernous sinus thrombosis

183
Q

Features of a venous sinus thrombosis

A

Signs and symptoms of venous sinus thrombosis include headache, visual changes, seizures, and focal neurological deficits.

Investigations: MRI or CT venography confirms diagnosis.

Management involves anticoagulation therapy (heparin, then warfarin), treating underlying causes, and sometimes thrombolysis.

184
Q

Causes of a venous sinus thrombosis

A

Pregnancy
Infection - local (orbital cellulitis)
Dehydration
Cancer
Trauma
Clotting disorders

185
Q

How does dipyridamole work

A

Non-specific phosphodiesterase inhibitor and decreases cellular uptake of adenosine

186
Q

Commonest complication in meningitis

A

Sensorineural hearing loss

187
Q

What is the organism that causes rocky mountain spotted fever

A

Rickettsia rickettsii

188
Q

Treatment for AF with chadvasc 0 (young fit male etc)

A

No treatment

189
Q

What is the role of IL 5

A

Eosinophills

190
Q

What is the role of IL10

A

Anti inflammatory

191
Q

What is the role of IL8

A

Promotes neutrophils

192
Q

What is the role of IL2

A

T cells CD4

193
Q

Valve abnormality in ADPKD

A

MV prolpase

194
Q

Barretts oeseophagus management - based on cell type

A

Non dysplasia- High dose PPI

Metaplasia- endoscopy is offerred.

Dysplasia- Radiofrequency ablation: preferred first-line treatment, particularly for low-grade dysplasia, endoscopic mucosal resection.

195
Q

What cell surface protein does EBV bind to

A

CD21

196
Q

What valve abnormality is associated with angiodysplasia

A

Aortic stenosis

197
Q

What is the treatment for EOL mouth discomfort

A

Benzydamine hydrochloride

198
Q

Where does dapagliflozin work

A

PCT

199
Q

Burkitts lymphoma translocation

A

T 8 14

200
Q

Where does spironolactone work

A

Cortical collecting duct

201
Q

IE treatment abx types based on staph, strep and other

A

if Staph: there is always flucloxacillin, if allergic then vancomycin
if prosthetic: add rifampicin
if strep: benzylpenicillin
for less sensitive: add gentamicin

202
Q

How to work out average BM from HbA1c

A

(2 X HbA1c) - 4.5

203
Q

Med contraindicated in absence seizures

A

Carbamazepine

204
Q

What allele are patients at risk of DRESS from allopurinol

A

HLAB5801

205
Q

MRI findings of Wernickes encephalopathy

A

Enhancement of mamillary bodies

206
Q

Commonest cancer from UVA therapy

A

SCC

207
Q

What areas of the brain are effected by hemiballism and huntingtons

A

Hemiballism - subthalamic nucleus of basal ganglia

Huntingtons - Striatum (caudate nucleus) of basal ganglia

208
Q

What nucleotide repeat is seen in huntingtons disease

A

CAG

209
Q

Drugs that trigger G6P deficiency

A

anti-malarials: primaquine
ciprofloxacin
sulph- group drugs: sulphonamides, sulphasalazine, sulfonylureas

210
Q

How does yellow fever present

A

flu like illness → brief remission→ followed by jaundice and haematemesis

211
Q

How does lassa fever present

A

WEST africa
viral hemorrhagic fever that can result in fever and bleeding from mucus membranes.

212
Q

Safest trycyclic

A

Lofepramine

213
Q

What chromosones are HLA genes on

A

6

214
Q

Most important SLE marker for disease severity

A

Anti-dsna titres

215
Q

Treatment for SVT in asthma

A

Verapamil

216
Q

Treatment for SEVERE lithium toxicity and what is the cut off

A

> 2.5mmol/l lithium - severe

Needs dialysis

217
Q

What test is best for allergy testing if a history of anaphylaxis is present

A

RAST test

218
Q

How can exercise affect fertility

A

In a very athletic woman, hypothalamic hypogonadism is a common cause of secondary amenorrhoea

Everything is normal or low compared ot premature ovarian failure where FSH would be raised

219
Q

How to differentiate between waldenstroms macroglobulinaemia and multiple myeloma

A

Waldenstrom’s macroglobulinaemia - Organomegaly with no bone lesions

Multiple myeloma - Bone lesions with no organomegaly

220
Q

When testing new drugs, what are superiority, equivalence and non-inferiority

A

Superiority - new drug better than old. Need huge sample size

Equivelance - If the confidence interval of the difference between the two drugs lies within the equivalence margin then the drugs may be assumed to have a similar effect

Inferiority - similar to equivalence trials, but only the lower confidence interval needs to lie within the equivalence margin (i.e. -delta). Small sample sizes are needed for these trials.

221
Q

How does leptin and gherlin work

A

Leptin Lowers appetite
Ghrelin Gains appetite

222
Q

How to differentiate between HUS and TTP

A

TTP has features of HUS (AKI, anaemia, thrombocytopenia) AND fever with confusion

223
Q

How long to give amitryptyline to work

A

trialled for a period of 6-8 weeks with at least 2 weeks at the maximum dose.

224
Q

What is the management for restless leg syndrome

A

Ropinirole

225
Q

Best stats test for a crossover study

A

Student paired T-test

226
Q
A
227
Q

What is the most thrombic predictor in anti-phospholipid syndrome

A

Lupus anticoagulant

228
Q

Name the inducers of the P450 system (reduce INR)

A

CRAP GPS

Inducers
Carbamazapine
Rifampicin
Alcohol (Chronic drinking)
Phenytoin, Primidone
Griseofulvin
Phenobarbitone
Sulphonyureas, Spironolactone, St. John Warts

229
Q

What lab test is best for chromosomal abnomalies

A

Fluorescence in situ hybridisation

230
Q

Medical therapy for WPW

A

Sotalol (not if AF though)

Amiodarone or flecanide

231
Q

Drugs cleared by haemodialysis (BLAST)

A

Barbiturate
Lithium
Alcohol (inc methanol, ethylene glycol)
Salicylates
Theophyllines (charcoal haemoperfusion is preferable)

232
Q

What is first line in BPH

A

Tamsulosin - alpha-1 antagonists

233
Q

What is the aim of statins in lowering cholesterol

A

In the primary prevention of CVD using statins aim for a reduction in non-HDL cholesterol of > 40%

234
Q

What is the commonest and severest form of renal disease in SLE patients

A

Diffuse proliferative GN - Class IV

235
Q

Treatment for restless legs

A

Ropinorole - dopamine agonist

236
Q

What is important to remember about the BCG vaccine

A

Poor at protecting against PULMONARY TB.

So if get infection - still TB risk even if had BCG vaccine

237
Q

What MMSE level to start memantine

A

<21

238
Q

Most dangerous tricyclic in an OD

A

Dosulepin

239
Q

Treatment given +abx in bacterial meningitis

A

Dexamethasone IF <4hrs since abx started

240
Q

What is the purpose of Z-score

A

Looks at secondary causes of osteoporosis

241
Q

Name some X-linked conditions

A

Fabrys
Duchennes/Beckers
Haemophilia
G6PD

242
Q

Hyatid cyst management

A

Surgery

243
Q

Most important treatment for non-CF Bronchiectasis

A

Postural drainage and chet physio

244
Q

Cancer most likely to get bone mets

A

Prostate cancer

245
Q

What anti-epileptic causes visual feild defects

A

Vigabratin

246
Q

How does radial tunnel syndrome differ from lateral epicoldylitis

A

Radial tunnel syndrome
- pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation

247
Q

Second line hypertensive after ACEI if oedema/HF

A

Indapamide

248
Q

Water deprivation test: cranial DI

A

urine osmolality after fluid deprivation: low

urine osmolality after desmopressin: high

249
Q

Causes and treatment for Non-gonococcal urethiritis

A

Causes - chlamydia (commonest), mycoplasma genitalium, ureaplasma, trochomonas vaginalis, E. Coli

Rx - doxy or azithromycin

250
Q

How does quinine toxicity present

A

ECG changes
Hypotension
Metabolic acidosis
Tinnitus
Hypoglycaemia
Visual disturbances
Pulmonary oedema

251
Q

Oncogene for medullary cancer

A

RET

252
Q

Difference between expressivity and penetrance

A

Expressivity - disease severity shown

Penetrance - likelihood of developing a condition if you have the affected gene.

253
Q

Most effective drug in stable angina

A

Aspirin

254
Q

Drug contraindicated in WPW

A

Verapamil

255
Q

Test required for HGV drivers/bus drivers for re-licensing post-ACS

A

Need a execsie test without symptoms or ECG changes

256
Q

The ONLY treatment for unstable AF

A

DC Cardioversion

257
Q

Virus for nasal cancer

A

Herpesvirus (EBV)

258
Q

How to tell difference between TACO and TRALI on exam

A

TACO - Hypertension
TRALI - Hypotension

259
Q

How does Zollinger-Ellison syndrome cause diarrhoea

A

Gastrinomas would lead to inactivation of pancreatic enzymes&raquo_space; Impaired absorption > Malabsorption diarrhoea.

260
Q

Damage to intrinsic muscles of the hand, what nerve root is affected

A

T1

261
Q

Acute treatment for hereditary angiooedema

A

C1 inhibitor concentrate IV

262
Q

How to differentiate left and right axial myomas

A

Left - TIA and strokes
Right - PEs and pulmonary HT

General - weight loss, malaise, night sweats, joint pains

263
Q

What is neuralgic amytrophy

A

Basically brachial neuritis - intense paina round shoulder then patchy neuropathy for a few weeks afterwards. Usually mild sensory features but LMNL signs with a wining scapula

Can be due to vaccines, childbirth, trauma,

264
Q

When to start bisphosphonates and not wait for a DEXA

A

Over 75 with fragility fracture

265
Q

Treatment for drug induced parkinsonism

A

Benzhexol

266
Q

What does Atrioventricular dissociation suggests on an ECG with wide QRS

A

Atrioventricular dissociation suggests VT rather than SVT with aberrant conduction

267
Q

What factors make campylobacter diarrhoea severe

A

severe infection and thus warrants antibiotic treatment:

the patient has a high fever and is passing more than 8 motions per day.

268
Q

What hormone is elevated in hypothalamic hypogonadism

A

Cortisol

269
Q

How to tell difference between usual interstitial pneumonitis and hypersensitivity pneumonitis

A

UIP - Dyspnoea, clubbing, crepetations

HP - ground glass shadowing

270
Q

Hormone levels for PCOS

A

Raised - testosterone and LH

Normal - oestrogen and FSH

271
Q
A

MRCP (4 decks)

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