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MRCP > Passmed deck 3 > Flashcards

Passmed deck 3 Flashcards

1
Q

Abx of choice for meingococcal meningitis with penicillin allergy

A

Chloramphenicol

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2
Q

Chagas disease commonest cause of death

A

Myocarditis

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3
Q

Dissemenated lymes disease rx

A

IV Ceftraxone

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4
Q

What is black water fever

A

Haemolysis, jaundice and AKI with haematuria due to malaria - fatal usually

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5
Q

What is melioidosis and the treatment

A

Bacterial infection caused by burkholderia pseudomallei and common in asia and australlia in flood seasons.

Usually presents with skin ulcers, pneumonia, visceral abscesses.

Difficult to treat but given IV ceftazidime or meropenem

Doxy erradication therapy

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6
Q

Diagnositic test with mycoplasma penumoniae

A

Serology

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7
Q

How does legionella present on a CXR

A

Mid to lower zone patchy bilateral consolidation

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8
Q

What does factor V leiden mutation result in

A

Activated protein C resistance

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9
Q

Test for hereditary spherocytosis

A

EMA binding test

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10
Q

Test for contact dermatitis

A

Skin patch test

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11
Q

How long should a person be monitored for a biphasic anaphylactic reaction

A

6hrs

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12
Q

Treatment given to Von willebrands disease patients to reduced bleeding risk for minor ops

A

Desmopressin for prophylaxis

Tranexamic acid for mild bleeding

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13
Q

How to differentiate a leukmoid reaction (raised lymphocytes due to non-cancer cause e.g. infection) and CML

A

leukocyte alkaline phosphatase score is low in CML, high in leukaemoid reaction

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14
Q

What ethnicity is most at risk of beign ethnic neutropenia

A

African afro-caribbean

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15
Q

Two commonest myeloproliferative causitive genes

A
  1. JAK2
  2. CALR (Calreticulin)
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16
Q

Aromatase inhibitors cause what (anastrazole)

A

Osteoporosis

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17
Q

SERMs like tamoxifen cause what

A

VTE and endometrial cancer

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18
Q

Gene affected in burkitts lymphoma

A

MYC gene

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19
Q

Common electrolyte abnormality with cisplatin

A

Hypomagnesia

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20
Q

What is the diagnosis - dyspnoea, obstructive spirometry pattern and RA

A

Bronchiolitis obliterans - treat with immunosuppression and supportive measures

CT - cetrilobualr nodules and bronchial wall thickening on CT

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21
Q

What work based lung disease exposure can predispose people to TB

A

Silica - impairs macrophages

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22
Q

Where does drug induced lung fibrosis occur

A

Lower zones

Work exposure lung diseases, rheumatoid diseases, TB all cause upper zone

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23
Q

Antibody to check if someone has worsening of asthma symptoms after starting LTRA

A

p-ANCA - Leukotriene receptor antagonists may trigger eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

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24
Q

How to differentiate early PE and anxiety on blood gas

A

Resp alkalosis + Normal PaO2 is Anxiety

Resp alkalosis + reduced PaO2 is PE

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25
Q

Farmers lung pathogen and presentation

A

Saccaropolyspora reticivugula

Dry, cough, fever, lethargy, dyspnoea (can be acute or chronic)

Mid and upper zone fibrosis on cxr
Bronchoalveolar lavage
NO eosinophilia

Give steroids

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26
Q

Criteria for LTOT

A

pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:

secondary polycythaemia
peripheral oedema
pulmonary hypertension

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27
Q

What lung cancer causes cavitating lesions

A

Squamous cell lung cancer

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28
Q

Name the condition - an acute form sarcoidosis characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia.

A

Lofgren’s syndrome

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29
Q

Antibody for esinophilia granulomatosis with polyangitis

A

ANCA

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30
Q

Organism that causes malt workers lung

A

Aspergillus clavatus

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31
Q

What is acute mountain sickness and how is it treated

A

Acute mountain sickness is generally a self-limiting condition. Develops over 12hrs to a few days.

headache
nausea
fatigue

Correlated to physical fitness
Treat with acetazolamide - it causes a primary metabolic acidosis and compensatory respiratory alkalosis which increases respiratory rate and improves oxygenation

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32
Q

What is high altitude pulmonary oedema and how is it treated

A

AMS can lead to HAPE - hypobaric hypoxia causing uneven vasoconstriction to lungs causing increased capillary pressure in areas and inducing pulmonary oedema.

Presents like pulmonary oedema

Rx - oxygen, descent, nifedipine and dexamethasone

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33
Q

What is high altitude cerebral oedema (HACE)

A

Cerebral vasodilation and increase blood flow and a leaky BBB causing cerebral oedema

Headache, ataxia, papilloedema

Treat with Descent and dexamethasone

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34
Q

One work exposure that does not increase cancer risk

A

Coal dust

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35
Q

Treatment for allergic bronchopulmonary aspergillosis

A

Pred

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36
Q

Causes of upper zone fibrosis (CHARTS)

A

CHARTS
C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis

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37
Q

What should be offered to HF with reduced ejection fraction patients on an ACEi/ARB and a beta blocker if they continue to have HF symptoms

A

Spironolactone

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38
Q

What clotting factors are affected by warfarin

A

1972

10
9
7
2

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39
Q

Exam findings of pulmonary HT

A

Loud S2
Right ventricular pulse is palpable
Raised JVP
Second heart sound loud over left upper sternal border

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40
Q

What is the treatemnt for preventing nitrate tolerance in ISMN use

A

Asymmetric dosing regimes - e.g. 8am and 2pm doses (gives nitrate free period and thus reduces tolerance)

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41
Q

What condition presents with TWI in V1 to V3 and epilson waves

A

Arrhythmogenic right ventricular cardiomyopathy is characterised by right ventricular myocardium replaced by fatty and fibrofatty tissue

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42
Q

How long is dual antiplatelet therapy given in drug eluting stent for PCI

A

12 months - delay any surgery until after that

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43
Q

Antithrombotic therapy for valve types

A

bioprosthetic: aspirin
mechanical: warfarin + aspirin

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44
Q

First line management for PHT once confirmed via right heart catheterisation

A

Acute vasodilator testing -
If reversibility -CCB
If non-reversible - prostacyclin analogues

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45
Q

What anginal med can cause ulceration anywhere in GI tract

A

Nicorandil

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46
Q

Treatment for acute pericarditis

A

NSAIDs
AND
Colchicine

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47
Q

What is syndrome X and how does it present

A

Microvascular angina

Has ST depression on exercise stress test but normal coronary arteries

Treat with nitrates.

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48
Q

What time of pulse is seen in mixed aortic valve disease

A

Bisferiens pulse -

This pulse is characterized by having two distinct systolic peaks separated by a mid-systolic dip.

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49
Q

What do the 4 heart sounds correspond to on an ecg

A

S1> peak of R wave

S2 >T wave

S3 > between t wave and p wave

S4 >p wave

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50
Q

What does troponin T bind to

A

Trapomyosin

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51
Q

How does papillary muscle rupture present

A

Rupture of the papillary muscle due to a myocardial infarction → acute mitral regurgitation → widespread systolic murmur, hypotension, pulmonary oedema

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52
Q

Prinzmetal angina treatment

A

Felodipine

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53
Q

What statins are more likely to cause myopathy

A

Simvastatin and atorvastatin

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54
Q

Deciding factor for bioprosthetic valve or mechanical valve

A

Give bioprosthetic if young as last longer

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55
Q

Mutation in what gene is the cause of HOCM

A

β-myosin heavy chain protein or myosin binding protein C

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56
Q

What med should be avoided in HOCM

A

ACEI

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57
Q

Persistent ST elevation following recent MI, no chest pain, whats the diagnosis

A

Left ventricular aneurysm

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58
Q

Drugs that cause ALT and AST rise

A

SV
Alcohol
Statins
TB drugs
Paracetamol
Phenytoin
Nitrofuratoin

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59
Q

Drugs that cause cholestasis +/- hepatitis

A

COCP
Fluclox, co-amox, erythromycin
Sulphonylureas

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60
Q

Causes of SAAG >=11

A

LIVER - raised ratio indicates portal hypertesion
Cirrhosis
ALF
Liver mets
Portal vein thrombosis

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61
Q

How does a villous adenoma present

A

Hypokalaemia
Mucus diarrhoea
Anaemia

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62
Q

What are the different lines of c.diff management for first presentation

A

First episode - oral vanc -> oral fidaxomicin –> oral vanc and IV metronidazole

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63
Q

What is the management of recurrent c.diff (within12 weeks)

A

Fidaxomicin

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64
Q

What is the treatment for life-threatening C.diff

A

oral vancomycin AND IV metronidazole

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65
Q

What is the level checked to check Hep B immunisation

A

Anti-Hbs

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66
Q

What are the three constituents of brush border enzymes

A

maltase: glucose + glucose
sucrase: glucose + fructose
lactase: glucose + galactose

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67
Q

How is c.diff spread

A

Faecal oral via spores

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68
Q

C diff monoclonal antibodiy for prevention of further episodes is?

A

Bezlotoxumab

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69
Q

How to prevent Hep B in newborns from positive mum

A

Give baby hep B vaccine and immunoglobulins

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70
Q

What blood test is used as a marker for pancreatitis severity

A

CRP
Lipase

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71
Q

How to tell difference between eosinophilic granuloamtosis with polyangitis and granulomatosis with polyangitis

A

GwPA - URT signs (sinusitis)

EGwPA - LRT signs (Asthma)

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72
Q

Sign of goodpasture disease on biopsy

A

IgG depsoits with anti-gm antibodies

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73
Q

Medication to reduce calcium renal stones

A

Bendroflumathiazide

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74
Q

Two types of membranoprolifative glumerulonephritis

A

1 - cryoglobulinaemia
2 - hep C

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75
Q

Lower eGFR than normal but >60 with normal kidneys. Whats the diagnosis ?

A

CKD: only diagnose stages 1 & 2 if supporting evidence to accompany eGFR

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76
Q

What renal stones are semi-opaque and what ones are radiolucent

A

cystine stones: semi-opaque
urate + xanthine stones: radio-lucent

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77
Q

Two diseases associated with progressive glomerulonephritis

A

Goodpastures
ANCA positive

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78
Q

Hyperacute rejection - what is the antibody

A

IgG

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79
Q

Antibodies associated with miller fischer syndrome

A

Anti-GQ1b

Different from GBS as more proximial, ataxia and affects eyes

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80
Q

Most important blood test for restless legs

A

Ferritin

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81
Q

How to differentiate between transient global amnesia and epilepsy amnesia

A

Epilepsy - lasts less than an hr, multiple attacks, stims

TGA - ca last up to 24hrs, repetitive questioning, no neurology

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82
Q

How do babies present if a mum takes phenytoin in pregnancy

A

Vit K deficiency - excessive bleeding

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83
Q

How to tell difference betwee vitreous haemorrhage and retinal detachment in exam qs

A

Look for RFs for bleeding - diabetes, anticoagulants. If present, more likely to be VH

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84
Q

Anti-vegf monoclonal antibody name

A

bevacuzimab

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85
Q

Red eye - glaucoma or uveitis?

A

glaucoma: severe pain, haloes, ‘semi-dilated’ pupil
uveitis: small, fixed oval pupil, ciliary flush

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86
Q

What do the bloods look like for Kallman syndrome

A

Kallman’s syndrome - LH & FSH low-normal and testosterone is low

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87
Q

What do the thyroid bloods for sick euythmic syndrome look like

A

TSH normal
Low T4 and low T3

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88
Q

What does pseudohyperkalaemia look like on bloods

A

High cell counts and high potassium

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89
Q

How to tell the difference between inulin and sulfonylurea induced hypoglycaemia

A

Sulfonylurea - Insulin and C-peptide Rise
(sulfonylurea makes pancreas release more insulin)

Insulin - Insulin Rise but C-peptide Low

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90
Q

What medication is given before GH pitutary adeoma transphenoid surgery and why

A

Octreotide - reduces size of tumour.

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91
Q

Diabetic med that can cause pancreatitis and renal failure

A

Exenatide

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92
Q

Joint condition in haemochromatosis

A

Pseudogout

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93
Q

Dermatomyositis most specific antibody

A

ANA most common but Anti-M2 most specific

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94
Q

Osteogenesis imperfecta occurs due to an abnormality in…

A

type 1 collagen

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95
Q

What is seen on sponal xray for Ankylosing spondylitis

A

subchondral erosions, sclerosis
and squaring of lumbar vertebrae

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96
Q

Commonest x-ray sign for RA

A

Juxta-articular osteopenia

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97
Q

What drug is risky if patients are allergic to aspirin

A

Sulfasalazine

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98
Q

What antibody is a marker of poor prognosis in RA

A

Anti-CCP antibodies

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99
Q

Two hormones for antiphospholipid syndrome

A

Cardiolupin and beta-2 glycoprotein abs

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100
Q

Rx for mediterranean fever

A

Colchicine

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101
Q

SLE antibody most associated with congenital HB

A

Anti-Ro

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102
Q

How does osteomalacia present

A

Bone pain, tenderness and proximal myopathy (→ waddling gait) → ?osteomalacia

Low vit D, low calcium and normal or raised ALK P and phosphate

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103
Q

Most common abs in mixed conective tissue disease

A

Anti-RNP

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104
Q

How does a zinc deficiency present

A

Dermatitis in acral, peri-orificial and perianal distribution → ?zinc deficiency

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105
Q

How does homocysturia present

A

Tall, long fingered, downward lens dislocation, learning difficulties, DVT - homocystinuria

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106
Q

How does Tay-Sachs disease typically present

A

developmental delay and cherry red spot on the macula, without hepatomegaly or splenomegaly

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107
Q

Where is most phosphate reabsorbed

A

PCT

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108
Q

Fabry disease inheritance and presentation

A

X-linked recessive - febrile episodes, burning pain with peripheral neuropathy of his hands and feet, angiokeratomas, crampy abdominal pain, hearing loss and renal failure.

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109
Q

What is Immune reconstitution inflammatory syndrome

A

a condition generally associated with HIV/immunosuppression, in which the immune system begins to recover, but then responds to a previously acquired opportunistic infection with an overwhelming inflammatory response that paradoxically makes the symptoms of infection worse.

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110
Q

What is MGUS

A

usually asymptomatic
no bone pain or increased risk of infections
around 10-30% of patients have a demyelinating neuropathy

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111
Q

How to differentiate myeloma from MGUS

A

MGUS has -

normal immune function
normal beta-2 microglobulin levels
lower level of paraproteinaemia than myeloma (e.g. < 30g/l IgG, or < 20g/l IgA)
stable level of paraproteinaemia
no clinical features of myeloma (e.g. lytic lesions on x-rays or renal disease)

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112
Q

What is mastocytosis and how is it diagnosed

A

Neoplastic proliferation of mast cells.

Get flushing uticaria on rubbing, abdo pain, monocytosis on blood film

Diagnose with urinary histamine

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113
Q

How does mercury poisoning present

A

visual field defects, hearing loss and paraesthesia

114
Q

What are the 4 stages of sleep

A

N1 - N2 - N3 - REM

Theta - sleep spindles - delta - beta

The sleep doctors brain

115
Q

When does dreaming, loss of tone and erections occur in sleep

A

REM sleep

116
Q

Drugs of zero-order kinetics

A

Phenytoin alcohol aspirin and salicylates

117
Q

What is whipples disease

A

Infection by tropheryma whipplei

Causes diarrhoea, weight loss, arthlagia, lymphadenopathy and ophthalmoplegia

Give oral co-trim for 1 year

118
Q

HLA allele for RA

A

HLA DR4

119
Q

What is Cryptogenic organizing pneumonia

A

Diffuse interstitial lung disase that affects distal bronchioles and alveoli of unknown cause.

Usually those in 50s

Sy - cough, malaise, fever, SOB, insipratory crackles,

Ix - leukocytosis, elevated ESR and CRP, Diffuse ground glass opacities

Give steroids

120
Q

Define osteopenia on DEXA

A

<-1 on measurement
<-2.5 is osteoporosis

121
Q

Test for herediatry spherocytosis

A

EMA binding test

Treatment is supportive.
Give splenectoym and folate long term

122
Q

How to differentiate hrediatary spherocytosis with G6PD Deficiency

A

G6PD Deficiency - male, african or mediterranian, intravascular haemolysis, heinz bodies

Herediatary spherocytosis - both sexes, northern europe and extravascular heaemolysis, sphereocytes

123
Q

What is wiskott aldrich syndrome

A

B and T cell dysfunction - x-linked disease of WASP gene.

Get eczema, low igM, low platelets and infections in chest

124
Q

Spinal area affected in subacute degeneration of spinal cord

A

Lateral corticospinal tracts and dorsal columns

125
Q

What to start first B12 or folate

A

B12

126
Q

How does Common variable immunodeficiency present

A

Low IgG, IgM and IgA. → recurrent chest and other infections

127
Q

What pathogen causes itchy rash on buttock or soles

A

Strongloides stercoralis - round worm

Ivermectin

128
Q

Burkitts lymphoma gene translocation

A

CMYC gene

129
Q

CML gene translocation

A

Tel-jak2

130
Q

What channel does flecainide work on

A

NAV1.5 Na Channels of the heart

131
Q

What is a common side effect of cyclophosphamide and how is it managed

A

Haemorrhagic cystitis - treat with mesena (detoxifies bladder)

132
Q

Drugs that can trigger acute intermittent porphyria attack

A

ABCS

Alcohol
Benzos + barbituates
COCP
Sulphonamides

133
Q

How does ethylene glycol poisoning present and how to treat

A

Like being drunk and blindeness due to formic acid accumulation causing optic neuropathy.

Give fomepizole - inhibits alcohol dehydrogenase

134
Q

What is acute promyelocytic leukaemia

A

Cuased by 15:17 translocation

Presents as younger age (25) type of AML. Usually presents with DIC or thrombocytopenia with good prognosis.

Treat with retinoic acid

135
Q

What is Waldenstrom’s macroglobulinaemia and how does it present

A

Lymphoplasmacytoid malignancy seen in older men.

Usually weight loss, lethargy, hyperviscosity, hepatosplenomegaly

Ix - IgM paraproteinaemia and bone marrow bopsy

136
Q

How to treat Waldenstrom’s macroglobulinaemia

A

Rituximab - CD20 inhibitor

137
Q

First line PD hypersalvation med

A

Glycopyrronium bromide

138
Q

What type of MIs is complete heart block treated in

A

Anterior MI

NOT treated in inferior MI

139
Q

What does a SAAG gradient of >=11g/L indicate

A

PORTAL HYPERTENSION - via -

HF, Cirrhosis, liver mets, budd chiari syndrome , portal vein thrombosis

140
Q

What throat infection can cause heart block

A

Diptheria - get grey membrane over tonsils

141
Q

What bacteria is associated with cat scratches and how does it present

A

Bartonella henselae - low grade fever, malaise and fatigue with ipsilateral lymphadenopathy.

Warthin starry staining

142
Q

How does leprosy present and how to treat

A

Mycobacterium leprae

Features - patches of hypopigmented skin and sensory loss over these

Give Congo treatment (DRC) - dapsone, clofazimine, rifampicin

143
Q

Prophylaxis for bacterial meningitis

A

Cipro or rifampicin

144
Q

How does leptospirosis present

A

Bilateral conjunctivitis, bilateral calf pains and high fevers in a sewage worker suggests leptospirosis

145
Q

How do macrolides work

A

Bind to ribosomal 50S subunit inhibiting translocation

146
Q

What is aplastic anaemia and what causes it

A

Pancytopenia with no abnormal infiltrate.

Causes -
Drugs - chloramphenicol, clozapine, chloroquine
EBV, Hepatitis, HIV, parovirus,
ALL
pregnancy
Idiopathic

Give ciclopsporin if severe

147
Q

3 causes of genetic deficiencies in neutrophils

A

Chronic granulomatous disease
Chediak-higashi syndrome
Leukocyte adhesion deficiency

148
Q

3 causes of genetic deficiencies in B cells

A

CVID
Brutons congenital agammaglobulinaemia
Selective immunoglobulin A deficiency

149
Q

1cause of genetic deficiencies in T cells

A

Di george syndrome

150
Q

4 causes of genetic deficiencies in T and B cells

A

SCID
Ataxic telangiectasia
Wiskott-aldrich syndrome
Hyper IgM Syndrones

151
Q

What is the role of desmopressin in treating Von Willebrand disease

A

induces release of von Willebrand’s factor from endothelial cells

152
Q

When is skin patch testing used

A

Used for contact dermaitis

153
Q

When is RAST testing used

A

Helps to determine amount of IgE - useful for food allergies

154
Q

What is the best and most common used allergy test

A

Skin prick test - cheap and quick

155
Q

How is alpah antitrypsin defiiency commonly inherited

A

Autosomal recessive/co-dominant fashion

156
Q

What is a normal alpha 1 antitrypsin deficiency allele

A

PiMM

157
Q

What are the two types of alleles for alpha 1 antitrypsin positive

A

PiSS - 50% normal
PiZZ - 10% normal (commonest cause of disease)

158
Q

Contraindications for lung cancer surgery

A

SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis

159
Q

3 things that raise transfer factor (TLCO) in lungs

A

Asthma
Pulmonary haemorrhage
Shunts (left to right)

160
Q

Extrinsic allergic alveolitis causes

A

bird fanciers’ lung: avian proteins from bird droppings
farmers lung: spores of Saccharopolyspora rectivirgula from wet hay (formerly Micropolyspora faeni)
malt workers’ lung: Aspergillus clavatus
mushroom workers’ lung: thermophilic actinomycetes*

161
Q

What are the 4 stages of sarcoidosis on a lung cxr

A

1 = BHL
2 = BHL + infiltrates
3 = infiltrates
4 = fibrosis

162
Q

4 causes of lower zone lung fibrosis

A

RAID -

Rheumatoid (except alk spond)
Asbestosis
Idiopathic
Drugs - methotrexate etc

163
Q

Commonest bacterial cause of aspiration pneumonia

A

Klebsiella

164
Q

How to determine from an ABG for COPD sat range

A

pCO2 normal - 94-98%
pCO2 high - 88%-92%

165
Q

What drugs flare up eosinophilic granulomatosis with polyangiitis

A

Montelukcast

166
Q

What condition is Anti-jo1 antibodies seen in the most

A

Polymyositis

167
Q

Difference between paroxysmal and persistent af

A

Paroxysmal self terminates
Persistent does not self terminate

168
Q

What are dexa scans compared to

A

Bone density of a young healthy adult

169
Q

If someone keeps asking the same questions with amnesia whats the diagnosis

A

Transient global amnesia

170
Q

What defect causes elhers danlos syndrome

A

Type 3 collagen

171
Q

What is pseudoxanthoma elasticum features

A

Autosomal recessive characterised by an abnormality in elastic fibres

retinal angioid streaks
‘plucked chicken skin’ appearance - small yellow papules on the neck, antecubital fossa and axillae
cardiac: mitral valve prolapse, increased risk of ischaemic heart disease
gastrointestinal haemorrhage

172
Q

What is foster-kennedy syndrome and how does it present

A

frontal lobe tumour - ipsilateral optic atrophy and papilloedema of the contralateral optic nerve.

173
Q

Does the BCG vaccine work against TB

A

No

Only works in children for TB meningitis and disseminated TB

174
Q

What medication is contraindicated in VT

A

Verapamil

175
Q

What HIV drug category are gravirs

A

Integrase inhibitors

176
Q

Vaccine for splenomegaly

A

ABC - pneum A Haem B men C.

Influenza end of year

177
Q

How do endothelin antagonists such as bosentan work in PHT

A

Endothelin causes pulmonary vasoconstriction (hence why antagonists are used in primary pulmonary hypertension)

178
Q

Best test for checking if cardiac resynchronisation therapy has worked

A

ECG

179
Q

How does yellow fever present

A

high fever, rigors, nausea & vomiting. Bradycardia may develop.

A brief remission is followed by jaundice, haematemesis, oliguria

180
Q

What is tardive dyskinesia and what causes it

A

Tardive kinesia can present as chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary choreoathetoid movements in patients on conventional antipsychotics

181
Q

Why is Retinoic acid given in APML

A

to force immature granulocytes into maturation to resolve a blast crisis prior to more definitive chemotherapy

182
Q

What is one of the only cancers that mets can be curative with surgical excision

A

Colorectal

183
Q

What is the difference between AA amyloidosis and AL amyloidosis

A

AL amyloidosis
the most common form of amyloidosis and due to myeloma/mgus etc.

AA Amyloidosis is due to infection/inflammation.

184
Q

How do thiazide diuretics work

A

inhibits sodium reabsorption by blocking the Na+-Clˆ’ symporter at the beginning of the distal convoluted tubule

185
Q

What mutation leads to carbapenem resistance

A

New delhi metallobeta lactamase 1

186
Q

Commonest hepaitis in pregnancy

A

Hep E

187
Q

SBP antibiotic choice

A

IV ceftaxime

188
Q

What hormonal abnormality can TB cause

A

Hypoaldosteronism

189
Q

What is paroxyzmal nocturnal haemoglobinuria

A

Intravascular haemolysis caused by sensitive cell membranes - more prone to clots, haemolytic anaemia and blood in urine in morning.

Do flowcytometry CD55-59

190
Q

Is haemophillia A or B more common

A

A- VIII

191
Q

How to differentiate between cold and warm autoimmune anaemia on blood film

A

In warm AIHA the haemolysis occurs extravascularly, so all you see on the film is fewer red cells. In cold AIHA it occurs intracvascularly, so you would see the lysed red cells on the film.

192
Q

What does abciximab work on

A

glycoprotein IIb/IIIa receptor antagonist

193
Q

How to tell difference between amoebiasis and giardiasis diarrhoea

A

Amoebiasis - dysentry

Giardiasis - bloating watery diarrhoea with 1-2 weeks of intubation

194
Q

What cytokine triggers vasodilation in sepsis

A

IL-1

195
Q

Tapeworm treatment

A

Albendazole

196
Q

What is parkinsonian malignant syndrome

A

Presents like neuroepileptic malignant syndrome - rigidity, fever, confusion.

Treat by restarting PD meds

197
Q

What happens to the calcium in hungry bone syndrome

A

Low

198
Q

How does faconi syndrome present on the bloods

A

Reabsorptive defect in PCT where there is increased excretion of nearly all amino acids, glucose, bicarbonate and phosphate

199
Q

Signs of refeeding syndrome (hypophosphataemia)

A

Cardiac - impairs myocardial contractility leading to HF
Resp - weak resp muscles
Renal - rhabdomyolysis
Haem - haemolysis
Neuro - seizures

200
Q

What is a conjugate gaze palsy and where is the lesion situated

A

Ipsilateral left eye unable to adduct and the contralateral right abduction nystagmus.

IPSILATERAL - paramedian area of the midbrain and pons (medial longitudinal fasciculus)

201
Q

List the adrenoreceptor agonists per receptor (Alpha 1 and 2) and (Beta 1,2)

A

Alpha-1 agonists
phenylephrine

Alpha-2 agonists
clonidine

Beta-1 agonists
dobutamine

Beta-2 agonists
salbutamol

202
Q

Features of organophosphate poisoning

A

BLUDS

Bradycardia, Lacrimation, Urination, Diarrhoea, Salvation

Give atropine

203
Q

King’s College Hospital criteria for liver transplantation (paracetamol liver failure)

A

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
- prothrombin time > 100 seconds
- creatinine > 300 µmol/l
- grade III or IV encephalopathy

204
Q

Use glucagon or atropine first in BB overdose

A

Atropine THEN glucagon

205
Q

How to differentiate acute tubular necrosis and acute interstitial nephritis

A

AIN - Similar to vasculitis. Aka esinophilia, rash, fever, white cells on dip. Usually liked to NSAIDs or allopurinol and sometimes beta lactams.

ATN - No systemic features, muddy clasts and caused by Gentamicin.

206
Q

What is CLL caused by

A

Monoclonal proliferation of B cells

207
Q

What is the first line treatment in flexural psoriasis

A

Topical steroids

208
Q

How does a non-functioning pituitary adenoma present on bloods

A

Slightly elevated prolactin with secondary hypothyroidism and hypogonadism - due ot stalk compression

209
Q

Commonest bacterial cause of meningitis in 6-60 yrs old

A

Strep pneumo

210
Q

What nodules are found on the mitral valve in rheumatic heart disease

A

Aschoff bodies

211
Q

How to differentiate between chronic and acute subdural haematoma on CT

A

Acute - hyperdense (white)
Chronic - hypodense (dark)

212
Q

Commonest site for ischaemic colitis

A

Splenic flexure

213
Q

How to remember if axonal or demyelinating condition on nerve conduction study

A

(A)xonal&raquo_space; (A)mplitude

(D)emyelinating&raquo_space; (D)eceleration

214
Q

Prosthetic heart valve antithrombotic therapy

A

bioprosthetic: aspirin

mechanical: warfarin + aspirin

215
Q

How to remember the different ligand types

A

ligand gated is a bipolar smoker (switches between GABA and glutamate)

tyrosine kinase is big, overweight, diabetic and lactating blood

guanylate cyclase is a romantic (ANP and BNP)

If in doubt, guess G protein (everything else

216
Q

How to differentiate tricuspid regurg and mitral regurg on exam

A

Tricuspid regurg becomes louder on inspiration

Mitral regurg does not become louder on inspiration

217
Q

What is calciphylaxis

A

Serious kidney complicaition - vasculopathy of small blood vessels

intensely painful, purpuric patches with an area of black necrotic tissue that may form bullae, ulcerate, and leave a hard, firm eschar

218
Q

What is ALWAYS required to diagnose dementia

A

Neuroimaging

219
Q

Treatment for benign essential tremor if asthmatic

A

Primidone

220
Q

When in ramadan should you take meds for DM

A

Majority at sunset and have long acting carb meal at sunrise

Pioglitazone needs no changes

221
Q

What is a common cause of deranged LFTs in HIV

A

sclerosing cholangitis due to infections such as CMV, Cryptosporidium and Microsporidia

222
Q

What is pseduohypoparathyroidism

A

Cells being insensitive to PTH.

Features - low IQ, Short, Short 4th adn 5th fingers, low calcium, high phospate and HIGH PTH

Measure urinary cAMP

223
Q

How to tell difference between bilateral renal artery stenosis and primary hyperaldosteronism on bloods

A

BOTH renin and aldosterone HIGH - renal artery stenosis

BOTH renin and aldosterone LOW - Liddles syndrome

High aldosterone and LOW renin - primary hyperaldosteronism

224
Q

What medication can cause vitamin A toxicity and how can it present

A

Retinoids - presents with bilateral papilloedema

225
Q

What is whipples disease - how does it present, GS investigation and management

A

Tropheryma whippelii infection in HLAB27 positive middle aged men.

Get diarrhoea, weight loss, large joint arthalgia, lymphadenopathy, hyperpigmented skin and photosensitivity

Investigate with jejunal biopsy (perioidic acid schiff granules) - PAS

Treat with co-trim for a year

226
Q

What is the treatment for third line diabetes if high BMI (<35)

A

Swap one of the drugs for GLP-1 mimetic

227
Q

What paraprotein is raised in waldenstrom macroglobulinaemia

A

IgM

Would be MGUS if asymptomatic

228
Q

Difference between barter syndrome and liddle syndrome

A

Barter - NKCC2 channel. Normotension and low K

Liddle - ENaC channel. Hypertension and low K.

229
Q

Commonest cause of death in systemic sclerosis

A

Interstitial lung disease and pulmonary arterial hypertension

230
Q

Deficiency in homcystunuria

A

Cystathioninebeta synthase

231
Q

Tuberous sclerosis features (4)

A

Shagreen patches
Cafe-au-lait spots
Retinal hamartomas
Renal angiomyolipomata

232
Q

Treatment for protein ligand 1 (PD L1) drugs (inflammation associated with cancer drugs (mab) drugs

A

High dose oral steroids

233
Q

How does an atrial septal defect present

A

ESM louder on inspiration

234
Q

How does botulism present and how do you treat

A

Usually from improperly canned foods or IVDU.
Get symmetrical descending nerve palsies - start in face and progress down to skeletal and respiratory muscles. GCS15/15, flaccidity
NO FEVER IS COMMON.

Need to give antitoxin asap

235
Q

Culture negative IE Cuase

A

Q fever - coxiella burnetti

236
Q

Synchronized cardiac resyn therapy - when to press button

A

On R wave

237
Q

A lesion where causes chorea

A

Caudate nucleus

238
Q

Difference between dermatitis artefacta and neurotic excoriations

A

Dermatitis artefacta - pt does not admit to it and does not care.

Neurotic excorations - pt admits to it

239
Q

Complications of schistosomasis mansoni

A

Liver failure and ascities

240
Q

Complications of schistosoma haematobium

A

Haematuria - SCC of bladder and bladder calcifications

241
Q

First line treatments for urinary incontinence

A

urge incontinence: bladder retraining
stress incontinence: pelvic floor muscle training

242
Q

Fragile X syndrome features

A

learning difficulties
large low set ears, long thin face, high arched palate
macroorchidism
hypotonia
autism is more common
mitral valve prolapse
Trinucleotide repeat disorder

243
Q

Pathophysiology of heparin-induced thrombocytopenia

A

antibodies form against complexes of platelet factor 4 (PF4) and heparin

244
Q

Secondary prevention in stroke and TIA

A

Clopidogrel

245
Q

Nerve root damage on klumpke paralysis

A

T1 - usually from swinging on tree branch with 1 hand

246
Q

Treatment for hereditary angiooedema

A

Anabolic steroids

247
Q

Blood results of treated syphilis

A

Negative non-treponemal test + positive treponemal test

248
Q

What does the golgi do to proteins to traffic them to lysosomes

A

Adds mannose 6 phosphate to them

249
Q

What cytokine does tuebrculin skin tests test for

A

Interferon Y

250
Q

How does anterior ischaemic optic neuropathy present on exam

A

swollen pale disc and blurred margins

251
Q

What type of antibody is rheumatoid factor

A

IgM antibody against IgG

252
Q

How does a lesion in the corpus callosum present

A

Alexia (inability to read), without agraphia (inability to write). This occurs because of an infarction of the corpus callosum

253
Q

When to give bolus of hypertonic saline over slow bag

A

If rapid and acute hyponatraemia (marathon runner etc)

254
Q

How does anterior spinal artery syndrome present

A

Bilateral spastic paresis and loss of pain and temperature sensation - anterior spinal artery occlusion

255
Q

Name some roles of TNF-Alpha

A

Stimulates HPA axis
Angiogenesis
Appetite suppression
Phosphorylation of insulin (increases insulin resistance)
Recruits nutrophils
Release of prostoglandins

256
Q

Erectile dysfunction management in haemachromatosis

A

Testosterone

257
Q

Drugs associated with pulmonary HT development

A

Amphetamine and cocaine use

258
Q

Anti-epileptic that is fine in liver disease

A

Leviteracetam

259
Q

What does troponin I,T and C bind to

A

C - Calcium
T - Tropomyosin
I - Actin

260
Q

Two roles of nitric oxide

A

Vasodilation and inhibits platelet aggregation

261
Q

Discoid lupus rx line 1 and 2

A

Topical steroids
Oral hydroxychloroquine

262
Q

Difference between oral allergy syndrome and food allergy

A

OAS - Localised symptoms

Food allergy - systemic symptoms with diarrhoea etc

263
Q

Drugs to stop and when for urea breath test

A

no antibiotics in past 4 weeks

no antisecretory drugs (e.g. PPI) in past 2 weeks

264
Q

What is pulsus alternans and what does it suggest

A

Pulsus alternans is when the upstroke of the pulse alternatives between strong and weak. It indicates systolic dysfunction and is seen in patients with heart failure.

265
Q

Common organ toxicity with trastuzumab

A

Cardiac toxicity - need echo beforehand

266
Q

Organism associated with lymphogranulma venereum

A

Chlamydia trachomatis - essenital when chlamydia invades the lymph system

267
Q

What does sickle cell do to the spleen

A

Many crises causes many infarctions which causes hyposplenism

268
Q

Multifocal atrial tachycardia rx

A

Verapamil

269
Q

What does anti-HbeAb show

A

Acute Hep B (E for emergency)

270
Q

What does HBsAb and HBcAb mean

A

Chronic infection

271
Q

Whats important to remember between nerve root radiculopathies and peripheral neuropathies in limbs

A

Specific peripheral nerves will not have forearm signs and signs will be sterotypical for nerve

Nerve root radiculopathies will have forearm signs

272
Q

Features that raise GH

A

Exercise
Hypoglycaemia
Stress - illness or emotional disturbance

273
Q

How does polyarteritis nodosa present

A

Weight loss, abdo pain on palpation and percussion (mesenteric vasculitis), myalgia and fever

ANCA negeative
Associated with hep B

274
Q

ALL - what is immunophenotyping and cytogenics used for

A

DI CP

Diagnosis - immunophenotyping

Cytogenics - prognosis

275
Q

Treatment if AF occured in last 48hrs

A

Amiodarone

276
Q

How doe sthe pityriasis rosea rash present

A

Herald patch with a number of erythematous lesions - no treatment needed

277
Q

Hep C treatment

A

Simepravir and sofosbuvir

278
Q

What does the BCR/ABL gene code for

A

Tyrosine kinase

279
Q

Where is BNP released

A

Ventricles

ANP - released by cardiac atria

280
Q

Treatment for malaria - plasmodium vivax

A

Has cycle stage as eggs in liver so needs chloroquine and primaquine to prevent it coming back

281
Q
A

MRCP (4 decks)

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