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MRCP > Passmed deck 2 > Flashcards

Passmed deck 2 Flashcards

1
Q

Give examples of type 2 hypersensitivity reactions

A

Blood - IgG or IgM binds to antigen on cell surface

  • Autoimmune haemolytic anaemia
  • ITP
  • Goodpasture’s syndrome
  • Pernicious anaemia
  • Acute haemolytic transfusion reactions
  • Rheumatic fever
  • Pemphigus vulgaris / bullous pemphigoid
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2
Q

Give examples of type 1 hypersensitivity reactions

A

Anaphylactic -

Anaphylaxis
Atopy (e.g. asthma, eczema and hayfever)`

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3
Q

Give examples of type 3 hypersensitivity reactions

A

Complex

  • Serum sickness
  • Systemic lupus erythematosus
  • Post-streptococcal glomerulonephritis
  • Extrinsic allergic alveolitis (especially acute phase)
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4
Q

Give examples of type 4 hypersensitivity reactions

A

Delayed - t-cell mediated

  • Tuberculosis / tuberculin skin reaction
  • Graft versus host disease
  • Allergic contact dermatitis
  • Scabies
  • Extrinsic allergic alveolitis (especially chronic phase)
  • Multiple sclerosis
  • Guillain-Barre syndrome
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5
Q

Commonest finding on gram stain for neutropenic sepsis and why

A

Gram positive cocci

coagulase-negative, Gram-positive bacteria are the most common cause, particularly Staphylococcus epidermidis
this is probably due to the use of indwelling lines in patients with cancer

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6
Q

Give an example of a NMDA antagonist and a GABA antagonist

A

NMDA - Memantine

GABA - Baclofen

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7
Q

How to remember molecular biology lab techniques

A

SNOW DROP

Snow - South NOrth West
Drop - DNA - RNA - Protein

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8
Q

Type of retinopathy associated with hydroxychloroquine

A

Bulls eye retinopathy

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9
Q

How does human african trypanosomiasis present

A

Two forms of sleeping sickness caused by protozoa -

Trypanosoma gambiense in West Africa and Trypanosoma rhodesiense in East Africa.

Both types are spread by the tsetse fly.

Presentation -
Trypanosoma chancre (painless nodule at infeciton site)
Intermittent fever
Enlarged cervical lymph nodes
CNS involvement - sleep awake cycle change, mood changes, headaches, meningoencephalitis.

Treat with IV pentamidine or suramin
CNS involvement - IV melarsoprol

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10
Q

What is strongyloidiasis and how does it present

A

Caused by nematode - Strongyloides stercoralis
Mostly tropical countries
Spread by faecal-oral root

Presentation -
Papular rash on feet or buttocks that is itchy (larve into body)
Most patients are typically asymptomatic but can present with vague abdominal symptoms of abdominal pain and diarrhoea.
Eosinophilia on a blood test may be the only sign of infection in some patients
Stool cultures will show larvae within the stool.

Treatment is typical with ivermectin

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11
Q

Two key blood tests for haemochromatosis monitoring

A

Ferritin and transferrin saturation are used to monitor treatment in haemochromatosis

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12
Q

How to remember role of iron studies via financial analogy

A

iron = loose change in your pocket
transferrin sat = money in your wallet
ferritin = bank savings
TIBC = greediness for more money

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13
Q

Main difference between presentation of basement membrane disease and IgA nephropathy

A

BMD - presents with microscopic haematuria

IgA nephropathy - presents usually with persistent haematuria when infection

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14
Q

What is the complement system

A

an integral part of the innate immune system, consists of a series of plasma proteins that collaborate to eradicate pathogens, promote inflammation, and fine-tune the adaptive immune response. Complement proteins are involved in chemotaxis, cell lysis and opsonisation. Deficiencies in the complement system can increase susceptibility to infections, autoimmune disorders, or other conditions.

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15
Q

What does C1 deficiency cause

A

Hereditary angioedema

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16
Q

What does C1q, C1rs, C2 and C4 deficiency cause

A

Immune complex diseases -

SLE
Henoch-Schonlein Purpura

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17
Q

What does C3 deficiency cause

A

Recurrent bacterial infections

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18
Q

What does C5 deficiency cause

A

Leiner disease - recurrent diarrhoea, wasting and seborrhoeic dermatitis

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19
Q

What does C5-C9 deficiency cause

A

Neisseria meningitidis

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20
Q

When to refer for surgery for aortic stenosis

A

if asymptomatic then observe the patient is a general rule
if symptomatic then valve replacement
if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery

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21
Q

How does pulmonary hypertension present

A

Endothelin disruption is key factor. Likely to develop due to secondary COPD or other chronic lung diseases. Can be inherited.

Sy - progressive exertional dyspnoea, oedema, cyanosis, right ventricular heave, loud P2, raised JVP with prominent ‘a’ waves, tricuspid regurgitation

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22
Q

How is pulmonary hypertension managed

A

Treat underlying conditions
Vasodilator testing -
- if positive response then CCB
- if negative response - iloprost then bosentan then sildenafil

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23
Q

Cause of persistent ST elevation post-MI

A

Left ventricular aneurysm

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24
Q

What drug is used for absence seizures

A

Ethosuximide

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25
Q

How does osteomalacia present on bone profile bloods

A

Calcium and phosphate low

ALP and PTH high

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26
Q

How does pagets disease present on bloods

A

Normal - ca, PO, PTH
Raised ALP

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27
Q

When is mirabegron used for urge incontinence

A

useful in the elderly, with whom anticholinergic side effects from other drugs may be of concern.

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28
Q

How does amoebiasis present

A

Amoebiasis should be considered in the presentation of dysentery after a long incubation period (months long)
RUQ pain

Giardiasis has an intubation period of 1 month and does not cause RUQ pain

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29
Q

What is the most common cause of viral meningitis

A

Enteroviruses - coxsackievirus B or echovirus

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30
Q

Treatment for PJP that is severe

A

Trimoxazole and steroids

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31
Q

How does common variable immunodeficiency present

A

Common variable immunodeficiency - low antibody levels, specifically in immunoglobulin types IgG, IgM and IgA. → recurrent chest and other infections

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32
Q

What cells are impaired in Chediak-Higashi syndrome and chronic granulomatous disease

A

disorders associated with neutrophil dysfunction predisposing to recurrent bacterial infections.

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33
Q

How does central retinal vein occlusoin present

A

Central retinal vein occlusion - sudden painless loss of vision, severe retinal haemorrhages on fundoscopy

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34
Q

How does central retinal artery occlusion present

A

It would also present as a sudden painless loss of vision; however, fundoscopy would show a pale retina with a cherry-red spot at the macula.

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35
Q

How would a virtrous haemorrhage present

A

his would be caused by bleeding, usually from new vessels formed as part of diabetic retinopathy. On fundoscopy, the red reflex may be absent and the retina may be obscured by the bleeding.

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36
Q

How does Amaurosis fugax present

A

In amaurosis fugax, a transient loss of vision occurs progressively, classically like a curtain coming down.

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37
Q

First line PD treatment

A

For first-line treatment:
if the motor symptoms are affecting the patient’s quality of life: levodopa
if the motor symptoms are not affecting the patient’s quality of life: dopamine agonist (non-ergot derived), levodopa or monoamine oxidase B (MAO-B) inhibitor

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38
Q

How does diphtheria present

A

It presents with severe tonsillitis, neck swelling. Sequelae include myocarditis and rhythm abnormalities (in particular heart block)

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39
Q

What antibody is found in mixed connective tissue disease

A

Anti-ribonuclear protein (anti-RNP)

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40
Q

When is pacing given for complete heart block post-MI?

A

Complete heart block following an inferior MI is NOT an indication for pacing, unlike with an anterior MI

Inferior MI HB is usually temporary (days long)

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41
Q

How to differentiate between viral meningitis and TB meningitis on LP

A

The CSF lymphocytosis combined with a glucose greater than half the serum level points towards a viral meningitis.

TB meningitis is associated with HIGH lymphocytosis and a low CSF glucose

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42
Q

How does aplastic crisis present in sickle cell

A

Low Hb with low reticulocyte count, usually due to parovirus B-19

Due to bone marrow failure

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43
Q

How does acute chest syndrome present

A

Basically PEs - has infiltrates on CXR

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44
Q

How does essential thrombocythemia present and what is its treatment

A

Myeloproliferative disorder - overlaps with CML

High platelet count
Burning sensation in hands
Normal Hb
JAK2 mutation in 50%

Treat with hydroxyurea

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45
Q

What Cytokine is produced by natural killer cells and T helper cells to fight viral illnesses and granulomatous disease (e.g. TB)

A

Interferon-gamma

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46
Q

What do you treat recurrent c. diff with

A

A recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with oral fidaxomicin

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47
Q

4 stages of keith Wagener classification for hypertensive retinopathy

A

I - narrowing
II - nipping
III - cotton wool and haemorrhages
IV - papilledema

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48
Q

How does acute intermittent porphyria present

A

abdominal: abdominal pain, vomiting
neurological: motor neuropathy
psychiatric: e.g. depression
hypertension and tachycardia common

Urine turns deep red on standing

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49
Q

Pharmacodynamics of how aspirin works

A

decreases the formation of thromboxane A2 resulting in decreased platelet aggregation

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50
Q

Treatment for chlamydia in preganancy

A

Azithromycin, erythromycin or amoxicillin may be used to treat Chlamydia in pregnancy

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51
Q

First line test for chlamydia

A

Women - NAAT swab
Men NAAT urine test

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52
Q

What determines transmission rates for HIV

A

High viral load

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53
Q

Overgrowth of what bacteria causes Bacterial vaginosis

A

Gardnerella vaginalis

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54
Q

Name 5 live attenuated vaccines

A

BCG
MMR
Influenza
Varicella
Yellow fever
Polio

Live vaccines (MY BOI)

  • MMR
  • Yellow fever
  • BCG
  • Oral rota, typhoid, polio
  • Influenza (intra nasal)
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55
Q

Treatment for HIV needlestick

A

Combination antiretrovirals and repeat HIV test in 12 weeks

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56
Q

Prophylactic treatment for splenectomy (2 weeks before removed if possible) - PIMP

A

Influenza, pneumoccocal, meningitis
Penicillin

Infection usually occurs from encapsulated organisms - H. influenzae, TB

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57
Q

What is seen on PCP broncholavage

A

bronchoalveolar lavage (BAL) often needed to demonstrate PCP (silver stain shows characteristic cysts)

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58
Q

Different CThead/MRI brain signs of space occupying lesion in immunocompromised patients

A

Toxoplasmosis - usually single or multiple ring enhancing lesions, mass effect may be seen

Primary CNS lymphoma - associated with EBV. Single or multiple homogenous enhancing lesions

Cryptococcus - meningeal enhancement, cerebral oedema. Usually meningitis though.

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59
Q

What can aerosolized pentamidine cause for PCP

A

Spontaneous pneumothorax

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60
Q

Treatment for Mycobacterium avium complex (MAC)

A

Rifampicin
Ethambutol
Clarithromycin

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61
Q

What is a Jarisch-Herxheimer reaction, how does it present and how is it treated

A

an acute febrile reaction that occurs within the first 24 hours of initiating treatment for spirochetal infections, such as syphilis

It is characterized by fever, chills, headache, myalgia, and exacerbation of skin lesions. The reaction is believed to be due to the release of endotoxin-like substances from the dying spirochetes. The symptoms usually resolve within a few hours to a day.

Rx - paracetamol

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62
Q

Commonest gram positive cocci with coagulase negative to cause UTI in young women

A

Staph saprophyticus

Catalase + = Staphylococcus

Catalase + & Coagulase + = Staphylococcus aureus
Catalase + & Coagulase - & Novobiocin + = Staphylococcus epidermidis
Catalase + & Coagulase - & Novobiocin - = Staphylococcus saprophyticus

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63
Q

What do all integrase inhibitors finish with in HIV

A

Gravir

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64
Q

What do all protease inhibitors finish with in HIV

A

Navir

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65
Q

When is treatment given for chlamydia

A

Based on known exposure of infection NOT based on a/w test result

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66
Q

Best test for ACTIVE syphilis

A

Rapid plasma reagin

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67
Q

How to differentiate TB and cryptococcal meningitis based on LP and clinical picture

A

More likely TB if -
insidious onset
Very high protein
Low glucose in csf

Both cryptococcal and TB will have lymphocytic CSF with high protein and low glucose

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68
Q

Who should be offered HPV vaccine

A

men who have sex with men under the age of 45 -

To protect against anal, throat and penile cancers

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69
Q

What is the treatment for campylobacter and when is it given

A

Immunocompromised patients
OR
Severe - multiple episodes loose stool, bloody diarrhoea, fever

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70
Q

When should dexamethasone be given for bacterial meningitis

A

IV Dex every 6hrs with first dose of abx until proven NOT to be strep

DO NOT GIVE IF SEPTIC

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71
Q

Rx for cryptosporidium diarrhoea

A

Supportive therapy

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72
Q

Treatment for toxoplasmosis in immunocompetent

A

No treatmentF

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73
Q

First line HIV test choice

A

HIV ELISA antibody
AND
p24 antigen test

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74
Q

Treatment for viral meningitis

A

No treatment required - antivirals have no benefit.

Usually self-limiting

Usually do get aciclovir and abx though until results are back

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75
Q

Treatment for bite/ open wound with regards to tetanus

A

Patient has had a full course of tetanus vaccines, with the last dose < 10 years ago
- no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity

If vaccination history is incomplete or unknown
- reinforcing dose of vaccine, regardless of the wound severity
- for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin

Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago
- if tetanus prone wound: reinforcing dose of vaccine
- high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin

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76
Q

How does a disseminated gonococcal infection present

A

Tenosynovitis
Migratory polyarthritis - sterile
Dermatitis

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77
Q

HIV drugs rule of thumb for guessing mechanism of ation

A

NRTIs end in ‘ine’
Pis: end in ‘vir’
NNRTIs: nevirapine, efavirenz

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78
Q

What kind of RBCs are associated with DIC

A

Schistocytes

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79
Q

What is cryoglobulinaemia and what are the 3 types

A

Cryoglobulinemia is a medical condition in which the blood contains large amounts of pathological cold sensitive antibodies called cryoglobulins – proteins that become insoluble at reduced temperatures.

Type 1 - raynauds. Associated with myeloma and waldenstrom

Type 2 - rhumatoid factor and associated with hep C, RA, sjorgens and lymphome

Type 3 - rheumatoid factor and assocated with RA and sjorgens

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80
Q

How is cryglobulinaemia managed

A

Treat underlying condition
Immunosuppression and plasmapharesis

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81
Q

patient presents with fatigue, anaemia with mild macrocytosis and massive splenomegaly (spleen crosses the midline). What is the diagnosis and what is seen on blood film

A

Myelofibrosis - ‘tear drop’ poikilocytes on blood film

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82
Q

What deletion of what chromosomes is a poor prognostic factor for AML

A

5 or 7

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83
Q

What is seen in AML blood film

A

Auer rods

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84
Q

How to remember cold and warm autoimmune haemolytic anaemia causes

A

G - Ghana, nice and warm

Ghana is outside (extra) UK so causes extravascular haemolysis (Ie spleen causing splenomegaly)

M - Manchester, cold.

Manchester is inside (or intra) UK so IgM causes intravascular haemolysis.

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85
Q

Commonest type of hodgkins lymphoma

A

Nodular sclerosing

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86
Q

What is paroxysmal nocturnal haemoglobinuria

A

Acquired haemolysis due to increased sensitivity of cell membranes

Get haemolytic anaemia and dark coloured urine

Diagnose with flow cytometry of blood for CF 59 and 55 levels

Treat with transfusions and eculizumab

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87
Q

Most important RF for AML prognosis

A

Cytogenetics for chromosomal abnormalities

Immunophenotyping for diagnosis
Cytogenetics for prognosis

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88
Q

What is herediatary angiooedema

A

Autosomal dominant condition of low plasma levels of C1 inhibitor

Painful macular rash and then painless swelling of face. No uticaria

Acute - FFP is given. Does NOT respond to adrenaline or steroids

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89
Q

How to determine between haemolytic uraemic syndrome or thrombocytopenic papura

A

Neuro signs point towards TTP

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90
Q

Gold standard treatment for prophylaxis for tumour lysis syndroe

A

Rasburicase

allopurinol is not as effective

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91
Q

Features of lead poisoning

A

Abdominal pain, constipation, neuropsychiatric features, basophilic stippling → lead poisoning

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92
Q

Features for poor prognosis for hodgkins

A

B symptoms

age > 45 years
stage IV disease
haemoglobin < 10.5 g/dl
lymphocyte count < 600/µl or < 8%
male
albumin < 40 g/l
white blood count > 15,000/µl

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93
Q

Commonest cause of antithrombin III deficiency

A

CKD

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94
Q

Commonest cause of TTP

A

Acquired inhibition of the protein ADAMTS13

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95
Q

Palliative care treatment for pain with SEVERE renal failure

A

Oxycodone for moderate

For severe - Buprenorphine or fentanyl as not renally excreted

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96
Q

Asthma features with broncheictasis and eosinophillia and raised IgE. Whats the diagnosis

A

Allergic bronchopulmonary aspergillosis

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97
Q

C. Diff first and second line rx

A

1 - Oral vanc and IV metronidazole
2 - FIDAXOMICIN

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98
Q

What does gastrin do

A

Increases acid secretion by parietal cells

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99
Q

What does somatostatin do

A

Decreases acid and pepsin and gastrin

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100
Q

What does secretin do

A

Increases bicarbonate

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101
Q

What causes tertiary hyperparathyroidism

A

often seen in patients with end-stage renal failure and is thought to be due to prolonged secondary hyperparathyroidism

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102
Q

Primary polydipsia water deprivation test results

A

urine osmolality after fluid deprivation: high
urine osmolality after desmopressin: high

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103
Q

Primary hyperaldosteronism can present with… (Na, K, BP)

A

hypertension, hypernatraemia, and hypokalemia

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104
Q

hypothyroidism and progressive bilateral deafness in children, whats the diagnosis

A

Pendred’s syndrome

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105
Q

Give causes of hypokalaemia WITH hypertension and give causes of hypokalaemia WITHOUT hypertension

A

Hypokalaemia with hypertension -
Cushing’s syndrome
Conn’s syndrome (primary hyperaldosteronism)
Liddle’s syndrome
11-beta hydroxylase deficiency*

Hypokalaemia without hypertension -
diuretics
GI loss (e.g. Diarrhoea, vomiting)
renal tubular acidosis (type 1 and 2**)
Bartter’s syndrome
Gitelman syndrome

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106
Q

How to diagnose dermatitis herpetiformis

A

Skin biopsy

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107
Q

Two causes of eczema herpeticum

A

HSV (Commonest)
Coxsackie virus

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108
Q

Pompholyx eczema

A

Humidity due to sweating and high temps

109
Q

Herpes subtypes and their skin presentation

A

HHV-6—–>Pityriasis Rosea
HHV-7—–>Pityriasis Rosea
HHV-8—–>Kaposi’s Sarcoma

110
Q

Textbook SCC presentation

A

A non-healing painless ulcer associated with a chronic scar is indicative of squamous cell carcinoma (SCC)

111
Q

False positives for syphilis

A

SomeTimes Mistakes Happen Pal

SLE, TB, Malaria, HIV pregnancy

112
Q

3 meds for first line alzheimers disease

A

galantamine,
donepezil
rivastigmine

113
Q

What steroids have the lowest and highest glucocorticoid activity

A

Fludrocortisone - lowest

Dex and betmethasone highest

114
Q

What steroids have the lowest and highest mineralcorticoid activity

A

Hughest - fludrocortisone

Lowerst - Dex and betmethasone

115
Q

Antibodies for lambert eaton syndrome

A

Anti-VGCC Abs

116
Q

2 Causes of diffuse proliferative glomuerulonephritis

A

Post-strep
SLE

117
Q

Define syndesmophytes

A

ossification of outer fibres of annulus fibrosis

118
Q

How to differentiate between ATN and Acute interstitial nephritis in AKI

A

ATN - is not an inflammatory process so NO leukocytes in urine dip

AIN - IS an inflammatory process so will have leukocytes on urine dip

119
Q

What bacteria is contraindicated for lung transplant

A

Burkholderia cepacia

120
Q

Pathophysiology of TTP

A

Failure to cleave vWF normally

121
Q

What is MELAS and how does it present

A

Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes - presents progressively and before 40 - Diffusion-weighted MRI shows multi-focal, hyperintense cortical lesions.

Maternally inherited only

122
Q

Lab test for mutated oncogenes

A

PCR

123
Q

Commonest genetic cause of Downs syndrome

A

Nondisjunction

124
Q

What cell produces Interferon gamma

A

NK and T hepler cells

125
Q

What cell type causes a hyperacute organ rejection

A

B cells

126
Q

How does rasburicase work

A

recombinant version of urate oxidase, an enzyme that metabolizes uric acid to allantoin

127
Q

Features of falciparum malaria

A

schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia
complications as below

128
Q

Prophylactic abx for prosthetic valve IE

A

Vanc, gent and rifampicin

129
Q

Prophylactic abx for native valve IE

A

Amox +/- low dose gent

If severe or pen allergic - vanc and gent

130
Q

Treatment for strep viridans IE

A

Benzyl pen

pen allergic - vanc and gent

131
Q

Tretament for staph IE that is native

A

Fluclox

Fluclox rifampicin and low dose gent if prosthetic

132
Q

Pathophysioloy of LP headache

A

CSF leak from dura

133
Q

How do long half lives been drugs have to have a loading dose

A

Long half-life drugs are very lipophilic and absorbed by tissues which reduces SERUM BIOAVAILABILITY.

So - need loading dose to achieve stable therapeutic levels.

134
Q

How to endothelin receptor antagonists work

A

decrease pulmonary vascular resistance in patients with primary pulmonary hypertension

135
Q

Causes of false negative BNP readings

A

ACEI and ARBs and diuretics
Obesity

136
Q

Treatment for major bleed and on warfarin

A

stop warfarin, give intravenous vitamin K 5mg, prothrombin complex concentrate

137
Q

INR target for aortic and mitral mechanical valves

A

aortic: 3.0
mitral: 3.5

138
Q

Commonest site for atrial myxoma

A

Left atrium

139
Q

Which bariatric surgery is a patient most at risk of malabsorption

A

Biliopancreatic diversion with duodenal switch

140
Q

What anti-retroviral drug causes pancreatitis

A

Didanosine

141
Q

Screening tests for haemochromatosis -

A

General population - transferrin > ferritin

Family - HFE testing

142
Q

What is seen on jejunal biopsy for whipples disease

A

Periodic acid-Schiff (PAS) granules

143
Q

CAP with coldsores diagnosis

A

Strep pneumonia

144
Q

Sodium correction complications

A

Low to high –> brain will die (Pontine myelinolysis)
High to low –> brain will blow (Cerebral edema)

145
Q

How is C.diff managed (first line, second and third line)

A

first-line therapy is oral vancomycin for 10 days

second-line therapy: oral fidaxomicin

third-line therapy: oral vancomycin +/- IV metronidazole

146
Q

How is a recurrent episode of C.diff dealt with

A

Within 12 weeks - fidazomicin

After 12 weeks - oral vanc or fidaxomicin

147
Q

How is life threatening C diff managed

A

IV metronidazole and oral vanc

148
Q

What can point towards psoriatic arthiritis more than RA

A

DIPJs affected more in psoriatic arthiritis
Psoriatic arthiritis is usually younger ppl

149
Q

What is pituitary apoplexy

A

commonly seen in the presence of a pituitary tumour and is caused by bleeding into or impaired blood supply of the pituitary, This generally presents with sudden onset headache, followed by symptoms of non-functioning pituitary.

VERY acute compared to a pituitary adenoma

150
Q

Sterile pyuria and white cell casts in the setting of rash and fever should raise the suspicion of…

A

acute interstitial nephritis

Commonly due to abx

151
Q

What drug class is Tolvaptan

A

vasopressin receptor 2 antagonist

152
Q

What cardiac abnormality is associated with ADPKD

A

Mitral valve prolapse (systolic murmur with mid-systolic click)

Can also cause a dilated aortic root

153
Q

Treatment to start with goserelin in prostate Ca

A

Cyproterone acetate
(Dampen down the risk of tumour flare)

154
Q

How does binge drinking cause hypernatraemia

A

ADH suppresion causing polyuria

155
Q

Treatment for epididmyorchitis

A

ABCD -

Achey balls - cetriaxone and doxy

156
Q

BMI >25 in DM Type 1 Rx

A

Metformin + the insulin

157
Q

What abx increases MRSA risk

A

Cipro

158
Q

Osteomalacia bloods

A

Low serum calcium, low serum phosphate, raised ALP and raised PTH - osteomalacia

159
Q

Pathophysiology of idiopathic membranous GN

A

Anti-phospholipase A2 antibodies

160
Q

How does metformin work

A

Activation of the AMP-activated protein kinase (AMPK)

161
Q

How to tell difference between an audit and a service evaluation in questions

A

Clinical audit seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change

Service evaluations aim to review a clinical service for performance and outcomes, but not against any defined standards.

162
Q

How to remember MEN syndromes

A

MEN 1 - 3 ‘P’s - HyperParathyroidism, Pituitary tumours, Pancreatic tumours.

MEN 2a - 1 ‘M’ - medullary thyroid cancer (70%); 2 ‘P’s - HyperParathyroidism, Phaeochromocytoma.

MEN 2b - 2 ‘M’s - medullary thyroid cancer, Marfan’s; 1 ‘P’ - Phaeochromocytoma.

163
Q

Investigation for age-related macular degeneration

A

Fluorescein angiograhy

164
Q

Difference between vitreous haemorrhage and retinal detachment on Hx

A

VH - Sudden spots or floaters.
RD - flashing lights

165
Q

How to tell difference between avoidant and schizoid

A

Schizoid - they want to be alone because they prefer it and indifferent to praise/criticism

Avoidant- they want to be alone too..because they are afraid of being criticised by others

166
Q

Disease with a contraindication to getting pregnant

A

Pulmonary hypertension

167
Q

What type of thyroid cancer is more common in those with autoimmune thyroiditis

A

Lymphoma

168
Q

Ciclosporin side effects

A

everything is increased - fluid, BP, K+, hair, gums, glucose

169
Q

What are the 6 signs of crest syndrome and their antibody

A

a subtype of limited systemic sclerosis is CREST syndrome: Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia

associated with anti-centromere antibodies

170
Q

Commonest cardiac defect in downs

A

Endocardial cushion defect (AVSD)

171
Q

Two signs of hyposplenism on blood film

A

Target cells and howell jolly bodies

172
Q

How does steroid-induced acne present

A

monomorphic papular rash without comedones or cysts. This does not respond to acne treatment but improves on drug discontinuation

173
Q

When is hypertonic saline used in hyponatraemia management

A

3% saline used in acute hyponatraemia with symptoms <120mmol/l

174
Q

Klinefelters LH and testosterone levels

A

High LH and low testosterone

175
Q

High serum osmolality cut off for HHS

A

> 320

176
Q

Disproportionate microcytic anaemia (very small MCV -60-70) - think …

A

Beta thalassaemia trait

177
Q

In ALS is it synchronized or unsychrnozied shocks and whats the energy

A

120-200J and deliver unsynchronized

178
Q

How to know difference between atrial flutter and atrioventricular nodal re-entry tachycardia

A

Atrial flutter - HR 150

AVNRT - Usually higher, >150

179
Q

What valve abnormality is associated with Angiodysplasia

A

Aortic stenosis

180
Q

Why is malaria caused by plasmodium knowlesi dangerous

A

Shortest erythrocytic replication cycle so leads to high parasite counts in a short space of time

181
Q

How does brown sequard syndrome present

A

Same side - loss of pain sensation
Opposite side - loss of power and proprioception

182
Q

Keloid scar management

A

Intralesional steroids - triamcinolone

183
Q

What screening test is best for hereditary angioedema

A

C4 between attacks
C1 during attacks

184
Q

Two types of cancer from polycythaemia vera

A

AML
Myelofibrosis

185
Q

What is the treatment for CLL

A

FCR

186
Q

What is the treatment for Hodgkins

A

AVBD

187
Q

What is the treatment for non-hodgkins

A

R-CHOP

188
Q

What is the treatment for CML

A

Imatinib

189
Q

List the HLA types and their associated diseases

A

HLA-A3
haemochromatosis

HLA-B51
Behcet’s disease

HLA-B27
ankylosing spondylitis
reactive arthritis
acute anterior uveitis
psoriatic arthritis

HLA-DQ2/DQ8
coeliac disease

HLA-DR2
narcolepsy
Goodpasture’s

HLA-DR3
dermatitis herpetiformis
Sjogren’s syndrome
primary biliary cirrhosis

HLA-DR4
type 1 diabetes mellitus*
rheumatoid arthritis - in particular the DRB1 gene (DRB104:01 and DRB104:04 hence the association with DR4)

190
Q

What does an ICD do to driving DVLA license

A

Banned from group 2 (HGV)

Normal drivers - banned for a month if prophylactc and 6 months if actually had ventricular arrhythmia

191
Q

What medication is used in non-falciparum malaria to prevent relapse

A

Primaquine

Prima prevention

Acute - chloroquine (chloroquine clean)

192
Q

When not to use slgt2 inhibitors

A

If CKD or eat low amount of carbs

193
Q

When not to use pioglitazone

A

When bladder cancer hx or CHF

194
Q

How does granulomatosis with polyangitis present on renal biopsy

A

Crescentic GN

195
Q

What are rickettsiae

A

Gram negative intracellular parasites (e.g. Tick, flea etc).

Sy - headache, fever, rash, recent bite.

Rocky mountain fever - if US

196
Q

Name 8 features of severe aortic stenosis

A

narrow pulse pressure
slow rising pulse
delayed ESM
soft/absent S2
S4
thrill
duration of murmur
left ventricular hypertrophy or failure

197
Q

Name some features of degenerative cervical myelopathy

A

Sy - pain in neck, upper andlower limbs, loss of manual dexterity, loss of sensation distally, sometimes bowel and bladder issues.

Usually incorrectly treated for carpal tunnel.

GS test is MRI of cervical spine.

Urgent referral required for decompressive surgery.

198
Q

Heart abnormalities with carcinoid syndrome

A

Pulmonary stenosis and tricuspid insufficiency

199
Q

What is dubin-johnson syndrome

A

Dubin-Johnson syndrome is a benign autosomal recessive disorder resulting in conjugated hyperbilirubinaemia (therefore present in urine).

It is due to a defect in the cMOAT protein. This causes defective hepatic bilirubin excretion.

200
Q

What E allele is highest risk for alzheimers disease

A

E4 allele

201
Q

Treatment for nematodes (roundworms)

A

Ivermectin if strongyloides stercoralis or river blindness.

Bendazoles otherwise

202
Q

Treatment for tapeworms

A

Bendazoles

203
Q

How does familial mediterranean fever present and how is it treated

A

Autosomal recessive disorder.

Features - 1-3 days of attacks -
pyrexia
abdominal pain (due to peritonitis)
pleurisy
pericarditis
arthritis
erysipeloid rash on lower limbs

Rx - colchicine

204
Q

What does PIMZ mean in alpha antitrypsin deficiency

A

Alpha-1 antitrypsin: PiMZ = carrier and unlikely to develop emphysema if a non-smoke

205
Q

What disease can be reactivated by natalizumab

A

JC Virus

206
Q

What MRI sequence is used for MS

A

MRI FLAIR Sequence

MRI STIR for thyroid eye disease

207
Q

What is hemiballismus

A

Movement disorder characterised by very violent movements of the arm or limbs.

Caused by stroke/lesion in subthalamic nucleus

208
Q

What test in syphilis remains positive despite treatment

A

Treponema pallidum haemagglutination test (TPHA)

209
Q

Retroperitoneal organs

A

SADPUCKER

Suprarenal (adrenal glands)
Aorta
Duodenum
Pancreas
Ureters
Colon
Kidneys
Esophagus
Rectum

210
Q

How does holmes adie present

A

Holmes ADIe = DIlated pupil, females, absent leg reflexes

211
Q

What septal defects cause LBBB and RBBB

A

OS primum- LBBB= when in Primary school, you are LEFT alone by your parents

OS secundum- RBBB= when in Secondary school, you take the RIGHT path to success

212
Q

Feeding of choice in MND

A

PEG tube

213
Q

What statitistcal test calculates sample size

A

Power - the probability of (correctly) rejecting the null hypothesis when it is false

214
Q

What long volume is reduced in fat people

A

ERV

215
Q

antibodies in bullous pemphigoid

A

hemidesmosomal bp antigens

216
Q

Rabies rx

A

following possible exposure give immunglobulin + vaccination

217
Q

Features o both types of membanoproliferative gn

A

type 1 - hep c and cryglobulinaemia
type 2 - partial lipodystrophy

218
Q

Methadone OD cause of death

A

prolonged QT

219
Q

Porphyria cutanea tarda cause

A

inherited defect in uroporphyrinogen decarboxylase

220
Q

What does complete HB do to heart sounds

A

variable intesity of s1

221
Q

Second line anti-hypertensive in afrocarribean ppl

A

ARB NOT ACEI

222
Q

Commonest measles complication

A

Pneumonia

223
Q

How to work out the 3 leischmaniasis types (sand fly infections)

A

Leishmania braziliensis - mucocutaneous (Brazil=buccal)

Leishmania donovani (donoVani=Visceral)

Leishmania tropica/mexicana (topical=tropical)

Treat leishmaniasis from south america as higher risk of mucocutaneous leishmaniasis

224
Q

What is unusual about mumps meningitis on CSF

A

Low glucose with lymphocytosis

225
Q

Best imaging for local staging for upper GI cancer

A

Endoscopic US

226
Q

3rd line asthma management

A

Add LTRA

227
Q

Inheritance pattern of inherited ataxias

A

Autosomal recessive

228
Q

Deficiency in what vitamin/nutrient can cause dilated cardiomyopathy

A

Selenium

229
Q

What is autoinduction

A

The process through which a drug induces the enzymes responsible for its own metabolism, thereby reducing its efficacy.

Common with carbamazepine

230
Q

Features of lambert eaton syndrome

A

Repeated contractions lead to increase strength
Dry mouth
Hpofelxia
Proximal weakness
Impotence

231
Q

Dvla advice for MULTIPLE TIAs

A

Cannot drive for 3 months

232
Q

TFTs in normal pregnancy

A

Raised total T3 and T4 but normal fT3 and fT4 suggest high concentrations of thyroid binding globulin, which can be seen during pregnancy

233
Q

Commonest cause of IVDU IE

A

Staph aureus

234
Q

How to tell difference between MND and Subacute degeneration of spinal cord

A

MND - No sensory symptom, motor only

SDSC - Sensory and motor symptoms

235
Q

What can tacrolimus do to glucose tolerance

A

Impair ti

236
Q

What is the most important factor in predicting outcomes post-stemi

A

New systolic heart failure

237
Q

Investigation for pancreatic cancer

A

CT high resolution

238
Q

How do aromatase inhibitors work

A

Reduce peripheral oestrogen synthesis

239
Q

H pylori eradication therapy

A

PPI, Amox, clari

240
Q

Commonest cause of work-based asthma

A

Isocyanates

241
Q

Name of mitral stenosis surgery

A

Percutaneous mitral commissurotomy

242
Q

Insulin type to first start on as a type 1 and 2 diabetic

A

Type 1 - try basal bolus first. 2nd line twice daily ‘mixed’.

Type 2 - Start with isophane once or twice daily

243
Q

What is a normal anion gap

A

A normal anion gap is 8-14 mmol/L

244
Q

Medication for failed electrical cardioversion whilst awaiting cardioversion again

A

Amiodarone - 4 weeks worth

245
Q

Reason for raised phosphate in CKD

A

Lack of excretion

246
Q

Reason for inhaled steroids in COPD

A

reduced exacerbation frequency

247
Q

Synonm for pre-test probability

A

Prevelance of condition

248
Q

How does acute disseminated encepholomyelitis present

A

The answer is acute disseminated encephalomyelitis which is a neurological condition which occurs typically a few weeks following a viral illness or vaccination. It can present with motor weakness, encephalopathy, seizures and coma. It is found on T2-weighted MRI imaging which reveals poorly-defined hyperintensities in the subcortical white matter. These lesions can develop throughout the course of the illness and hence serial MRIs may be required.

Steroids and IV IG

249
Q

How does a craniopharinginoma present

A

Visual disturbances, headaches, diabetes insipidus, hypopituitarism

250
Q

False positive VDRL/RPR

A

‘SomeTimes Mistakes Happen’

(SLE, TB, Malaria, HIV)

251
Q

What disorder presents like functional - motor/sensory deficit

A

Conversion disorder

252
Q

How to tell difference between aide tonic pupil and argyll robertson pupil

A

Aide tonic pupil is unilateral and argyll robertson is bilateral.

Aide tonic will also have reduced reflexees

253
Q

Is toxoplasmosis serology useful in acute setting

A

No as just tells as that he has had an infection at some point - not if it is current or not

254
Q

Turners syndrome treatment

A

Oestrogen

255
Q

How to tell difference between OCPD and OCD

A

OCPD - Limited awareness

OCD - awareness

256
Q

Alteplase antidote

A

FFP

257
Q

Drugs that can cause a myasthenia crisis

A

D-penicillamine
Succinylcholine
Cipro and gent
Antiarrhythmics - procainamide
BB

258
Q

Ulcerating papule of nasal septum and recently been to south america, whats the diagnosis

A

Mucocutaneous leishmaniasis

If splenomegaly and ascities - visceral leishmaniasis

259
Q

How does a wuchereria bancrofti infection present

A

Lymphoaedma

260
Q

What to do with cabergoline for microprolatinoma if becomes pregnant

A

Stop med

261
Q

Diabetic meds that are avoided in egfr<30

A

Metformin
Sitagliptin

262
Q

What is human T cell lymphttrophic virus 1

A

African, lymphadenopathy, raised calcium - type of T cell lymphoma

263
Q

Rules for GROUP 2 drivers (HGV) and HF

A

Symptomatic heart failure will lead to revocation of a Group 2 licence, regardless of whether the symptoms lead to incapacity. If a patient on treatment becomes asymptomatic, then they may be relicensed only if their LVEF is >= 40%.

For Group 1 entitlements, the DVLA does not need to be informed of symptomatic heart failure if it does not lead to distracting or incapacitating symptoms.

264
Q

How does CANCA Lung disease present

A

Can get URT symptoms - mastoiditis, epistaxis, nasal saddling
Chest - cavitating lesions and alveolar changes.

265
Q

Treatment for diptheria infection

A

Diptheria antitoxin

266
Q

Mechanism of PPIs

A

Inhibits hydrogen potassium pump

267
Q

What treatment is given for carcinoid syndrome before surgery

A

Octeride - somatostatin analogue that reduces seratonin release

268
Q

Safetst DMARD for males wanting to start family

A

Hydroxychloroquine

269
Q
A

MRCP (4 decks)

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