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MRCP PART 1 > Past paper tit bits > Flashcards

Past paper tit bits Flashcards

1
Q

Which vitamin deficiency linked to colorectal Ca

A

Vit D

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2
Q

5cm plaque with inflamed border
Progress from thickened ->atrophic
May become hyperpigmented / ivory white over time

A

Morphoea

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3
Q

What dictates when to use Telapravir in HepC

A

HepC genotype

Genotype 1 has poor clearance and so use new agents such as Telapravir

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4
Q

STEMI going for PCI give what? If on oral anticoag?

A

Aspirin and prasugrel

Aspirin and clopidogrel

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5
Q

Woman (asymptomatic) who’s brother has haemophilia. What is risk of her son getting it?

A

25%

1 in 2 risk she has it
1 in 2 risk she passes on her dodge one

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6
Q

How does ticagrelor work

A

Platelet ADP receptor blocker

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7
Q

Aspirin mechanism

A

Cox-1 inhibitor

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8
Q

Cerebral toxoplasmosis rx = Pyrimethamine +

A

Sulfadiazine + folic acid

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9
Q

Biggest risk factor for suicide

A

Previous attempt

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10
Q

Cerebellar pontine tumour +calcification with no hearing loss / tinitus?

A

Meningioma

(if hearing loss = acousic neuroma)

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11
Q

Rheum A
Fever, dyspnea and multifocal consolidation =

A

Organising pneumonia

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12
Q

Usual time frame for MTX pneumonitis in Rheum A

A

4 months after starting MTX

CT shows pulm infiltrates

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13
Q

Alcoholic with urinary incontinence, peripheral neuropathy + reduced knee jerk =

A

B12 deficient

[B1 is just wernikes for exam]

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14
Q

How to screen for risk of steven johnsons syndrome
Eg if starting carbamazepine

A

HLA testing

HLA-B1502

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15
Q

Gram -ve bacilli causing cavitating pneumonia in big boozer

A

Klebsiella

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16
Q

Raised white/flesh colored lumps ? usually seen in? Cause?

A

Molluscum contagiosum
immunocompromised/
Children

Poxvirus

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17
Q

48 hour lag -> bloody diarrhoea

A

Campylobacter

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18
Q

70s when is loss of high frequency sounds presbycusis? Loss of cochlear hair cells?

A

Presbycusis - age related

Loss of cochlear hair cells - due to load noises Eg Gamekeeper, factory, war…

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19
Q

Key side effect of pethedine? When does it happen and why?

A

pethidine is metabolised to norpethedine
If renal impairment -> accumulates
->Seizures

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20
Q

What accumulates in renal failure and morphine administration

A

Morphine 6 - glucaronide

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21
Q

mid 20s with hereditary peripheral neuro symptoms -> ataxia? Inheritance?
Most common presentation?

A

Friedriecks ataxia
GAA repeat in frataxin gene

Unstable gait is usual presentation

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22
Q

Rheum A, now pancytopenic. What has happened

A

Felty syndrome (hypersplenism)

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23
Q

Haemarthrosis, factor VIII lower end of NORMAL and mild elevated APTT. Prev surgery with no issues =

A

Von Wilebrand

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24
Q

Karposi’s sarcoma virus

A

HHV 8

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25
Q

Rx of SVC obstruction

A

Stenting followed by consideration of radiotherapy

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26
Q

Bone and muscle pain, weakness, lethargy. Proximal myopathy
Low Ca, raised ALP =?

A

Osteomalacia
Needs calcium + vit D

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27
Q

Positively birefringent rhomboids =

A

Caclium pyrophosphate
[pseudogout / CPPD]

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28
Q

MRSA UTI rx

A

Doxy (or other tetracycline) if mild

IV vanc if severe

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29
Q

Why CLL get recurrent infections?

A

Hypogamaglobulinaemia

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30
Q

Diarrhoeal illness and acute hepatitis. Which Hep viruses in differentials?

A

A or E

Consider HepE if south east asia

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31
Q

Corneal reflex - explain and nerves involved

A

Touch cornea -> stimulates sensory branch of CN V (trigeminal)

Spinal trigeminal nucleus stimulates CN 7 facial nerve to cause both eyes to blink

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32
Q

How can you exclude adrenal insufficiency with synacthen test?

A

Cortisol rise of >200nmol/L
and 30 min level >600nmol/L

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33
Q

Who gets neuropathy with isonazid?

A

-NAT-2 deficient
-Slow aceytlators

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34
Q

2 mechanisms of nicorandil

A

Nitrate
Potassium channel agonist

Both lead to smooth muslce relaxation

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35
Q

2 drugs which can be used for myeloma

A

Thalidomide
Bortezomib

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36
Q

Blast cells and aeur rods on blood film and acute leukaemia (especially if young) which chromosomal thing?

What if CML?

A

t (15:17)

CML - philadelphia t (9:22)

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37
Q

Post partum, hyperthyroid. Postive TPO antibodies whats the cause

A

Post partum thyroiditis

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38
Q

Which 2 leukaemias does philadelphia chromosome cause

A

ALL
CML

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39
Q

3 poor prognostic factors in ALL ?

A

Males
WCC >50
Philadelphia chromosome

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40
Q

Active SLE with thrombocytopenia. What rx>?

A

DMARD
Eg hydroxycloroquine

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40
Q

Active SLE with thrombocytopenia. What rx>?

A

DMARD
Eg hydroxycloroquine

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41
Q

Which CD and which MHC class on
T helper
Cytotoxic T

A

T helper - CD4, MHC class 2

Cytotoxic - CD8, MHC class 1

Multiply toget to 8

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42
Q

Which IL in acute phase response. Drug to target each?

A

IL-1 - Anakinra

IL-6 - Toculizumab

Both used in Rheum A

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43
Q

IL-2 does what? Drugs targetting it?

A

Drives T cell proliferation Eg in tranplant rejection
Calceneurin inhibitors Eg Ciclosporin and tacrolimus

IL-2 in transplant rejection as 2 peoples organs there

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44
Q

Which IL is ANTI-inflamatory

A

IL-10

10/10 well done bud calming things down

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45
Q

Which IL is ANTI-inflamatory

A

IL-10

10/10 well done bud calming things down

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46
Q

Severe allergic asthma may get what -mab therapry

A

Anti-IgE
Omazilumab

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47
Q

Which Ig deficiency gets autoimmune disease

A

IgA

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48
Q

Which T helper cell in
Agressive inflam response?
Tollerant response eg preg?
Autoimmune disease?

A

TH -1

TH - 2

TH - 17 (secretes IL-17)

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49
Q

Why gynaecomastia in liver disease

A

Decreased steroid hormon catabolism
[specifically androstenedione -> increased substrate converted into oestrogens]

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50
Q

Why feminism in someone who is fat and drinks lots

A

increases aromatase activity

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51
Q

FVC in COPD
Inspiratory loop?

A

FVC often slightly low (due to gas trapping)
Normal inspiratory loop

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52
Q

Coeliac and then small bowel obstruction =

A

T cell lymphoma

Bacterial overgrowth would not lead to obstruction

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53
Q

Coeliac and then small bowel obstruction =

A

T cell lymphoma

Bacterial overgrowth would not lead to obstruction

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54
Q

Hayflick limit is?

A

Number of times a cell can divide

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55
Q

2 most common rescue therapies in IBD

A

Ciclosporin
Infliximab

Both have quick acting properties

Other immunosupressive Eg Azathioprine, 6-metacarporine take weeks

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56
Q

Throat infetion then couple weeks later - salmon pink patches with scales

A

Guttate psoriasis

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57
Q

Gastrocnemius nerve root?

A

S1/2 (tibial nerve)

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58
Q

Common drug which seems to reduce the risk of colon cancer

A

Aspirin
[and maybe NSAIDs]

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59
Q

Azathioprine / ciclosporin / methotrexate in preg?

A

Aza / ciclo can be continued

Stop methotrexate

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60
Q

Azathioprine / ciclosporin / methotrexate / sulphasalazine in preg?

A

Aza / ciclo can be continued

Stop methotrexate / sulphasalazine

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61
Q

Key risk of suphasalzine in preg

A

Baby born with haemolytic anaemia

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62
Q

Pulm / renal involvement only. 2 week course and really sick?

A

Goodpastures

GPA usually a bit slower with some sinus / upper stuff

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63
Q

Pulm / renal involvement only. 2 week course and really sick?

A

Goodpastures

GPA usually a bit slower with some sinus / upper stuff

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64
Q

Fomepazil mechanism ? Why do toxic alcohol peeps go blind?

A

Inhibits alcohol dehydrogenase
->prevents formation of formaldehyde -> formic acid -> acidosis and ocular toxicity

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65
Q

Dilsufiram mechanism

A

Inhibits aldehyde dehydrogenase

not alcohol dehydrogenase

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66
Q

Can you have DI with a normal serum osmolality ?

A

No
IT WILL BE HIGH

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67
Q

Can you have DI with a normal serum osmolality ?

A

No
IT WILL BE HIGH

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68
Q

Trip to africa
Now 6-12 weeks later
Fever and massive urticaria and rasied eosinophils?
What if after just a couple weeks?

A

Shitosomiasis -> eggs -> big reaction (Katayama fever)

Ascaris ssp (if soon after return)

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69
Q

How long Rx in schitz for symptoms to resolve

A

About 4-6 weeks

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70
Q

How long Rx in schitz for symptoms to resolve

A

About 4-6 weeks

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71
Q

Monozygotic twin with SLE whats risk?
Dizygotic?

A

25%

3%

72
Q

Monozygotic twin with SLE whats risk?
Dizygotic?

A

25%

3%

73
Q

Fatty with slightly low FEV1 and FVC with progressive SOB. What test to differentiate multiple small PEs and obesity hypoventilation.

A

Transfer coeeficient
Eg Kco 55% will be PEs

You dont get chest pain with small PEs

74
Q

How does ATG work

A

Depletes T cells
[inhibits monocyte-derived dendritic cells maturation]

75
Q

Anti La found in which 2 conditons most commonly

A

SLE
Sjorgrens

76
Q

Repaired Aortic aneurysm. Which class of drug most important for long term?

A

B blockers

Keep the BP low and minimise vessle stress

77
Q

Speaking in sentences but it is meaningless - Damage to? Where is this located?

A

Wernike’s
Superior temporal gyrus

78
Q

Unable to say sentences = damage to? Where is it found?

A

Brocas
Inferior frontal gyrus

79
Q

What is nephritic factor actually called?

A

Anti-C3bBb

Causes alternative complement pathway to be constantly stimulated

80
Q

What is most common non traumatic cause of a chylothorax

A

Lymphoma

81
Q

1st line Primary pulm HTN after a CCB? Mechanism ?

A

Bosentan
Endothelien A receptor antagonist

82
Q

Klebsiella osteomyelitis Abx

A

Tazocin

83
Q

Endocarditis with Strep Sanguinis blood culutres. What Ix for source?

A

Orthopantomogram

Sanguininis is usally from a dental abscess

84
Q

What causes the raised urate in tumour lysis

A

Neucleic acid breakdown

-> purines
->uric acid

85
Q

H+ pH conversion - 2 vaulues to remeber

A

ph 7.4 = h+ 40
ph 7 = h+ 100

86
Q

Lutembacher’s syndrome is?

A

a congenital atrial septal defect (ASD) complicated by acquired mitral stenosis (MS).

87
Q

Why do people who’ve had a big stroke stay cold?

A

Damage to hypothalamus
-Leads to an impaired catecholamine response

88
Q

Left Trochlear nerve palsy. How would patient tilt head when speaking to you?

A

Tild head to right

89
Q

When do you see bilateral scotomas

A

Methanol posioning

90
Q

Lesion in central scotoma is where

A

Optic nerve

91
Q

Antibodies in HIT

A

Anti PF4

[platelet factor]

92
Q

Visit Nepal/india and up to date with vaccines Acute symptoms. Which hepatitis do they have ? Incubation period?

A

HepE
2-9 weeks

93
Q

Contact dermatitis which hypersenitivity type?

A

Type 4

94
Q

Klebsiella pneumonia drug choice?

A

Tazocin

95
Q

Mechanism for PTH reducing PO4 in blood

A

Reduces proximal tubule reabsorbtion

96
Q

Septic arthritis gonorrhea Rx

A

Ceftriaxone

97
Q

Ballistic movements - where is damaged

A

Sub thalamic nucleus

97
Q

Ballistic movements - where is damaged

A

Sub thalamic nucleus

98
Q

Blueish discolouration of the skin caused by?

A

Amiodarone

99
Q

Blueish discolouration of the skin caused by?

A

Amiodarone

100
Q

Which cardiac drug causes mouth ulceration (and GI)

A

Nicorandil

101
Q

P Vivax initial Rx

A

Chloroquine
[followed by a course Primaquine]

102
Q

Difference between an auditory hallucination and a second-person auditory hallucination.

A

Auditory - ‘He wants to…’
-Commentary

Secondary - ‘You are going to…’
-Second person talking to you

103
Q

Pyoderma gangrenosum Topical/oral steroids?

A

Oral

103
Q

Pyoderma gangrenosum Topical/oral steroids?

A

Oral

104
Q

Worried about thyroid eye disease - what test can you do first?

A

Perimetry
[formal visual field testing]

105
Q

Target lesions, haemolysis and pneumonia likely?

A

Mycoplasma

106
Q

PVL staph - not responding to fluclox. What next?

A

Clinda
[Doxy, rifampicin other options]

107
Q

Where on the ECG is the 4th heart sound ? What is it?

A

P wave
Caused by atria contracting forcefuly to overcome a stiff ventricle

108
Q

Heart sounds
1
2
Where on ECG?

A

1 closure mitral/tricuspid
QRS

2 closure aortic / pulm
T

109
Q

where are ketones formed in DKA

A

Lypolysis

110
Q

DVT prophylaxis post acute stroke

A

Pneumatic compression boots

LMWH carries risk of bleed

111
Q

CKD why raised PTH

A

Low vit D
-> Low Ca

112
Q

Shallow painless ulcer on penis
enlarged lymph node in groin? bug? Rx?

A

Lymphogranuloma venereum
Chlamydia
Doxy 1 week

113
Q

Unconcious house fire. Metabolic acidosis, normal O2 sats. Ischemic ECG

A

CO posioning

114
Q

Chostochondritis - Do you need an Xray?

A

No

115
Q

Erythema nodosum and bilateral ankle arthritis - whats high on differential

A

Lofgren syndrome
[sarcoidosis -> needs a CXR]

116
Q

Pre menopausal woman with iron defiiency anaemia 1st line Ix?

A

TTG

117
Q

When is ivabradine used? Class

A

Heart failure with pulse > 75
HCN channel blockers
[Hyperpolarization and Cyclic Nucleotide ]

It works by slowing the heart rate so the heart can pump more blood through the body each time it beats

118
Q

Which class of drug is HIV most commonly resistant to?

A

Reverse transcriptase inhibitors

119
Q

Which class of drug is HIV most commonly resistant to?

A

Reverse transcriptase inhibitors

120
Q

Can you reduce O2 % in COPD if they have a PO2 < normal

A

No

Heading towards NIV

121
Q

What is lactate produced from?

A

Anaerobic metabolism from Pyruvate via lactate dehydrogenase

122
Q

Fly to Africa and bitten by Tetse fly? Months later now sleep/wake cycle becomes reversed + other general CNS / psych issues? Bug? Ix? Rx?

A

Trypanosoma Brucei species
[sleeping sickness]

CSF

Pentamidine

122
Q

Flu -> cavitating pneumonia. Which bug?

A

Staph Aureus

123
Q

Head injury -> persistent headaches, memory loss, lethargy. Slowly improving over several weeks

A

Post concussion syndrome

124
Q

Pleuretic chest pain relieved while sitting forward. Best Ix?

A

ECG - pericarditis
[trop wont be that exiting]

125
Q

Which part of antibody binds to a receptor on surface of phagocyte

A

Fc Portion

126
Q

Which part of antibody binds to a receptor on surface of phagocyte? Which part to bugs?

A

Fc Portion [FagoCyte]

Fab [Think Fab fragments finding to digoxin - or faBacteria]

127
Q

Travel.
Chronic fevers + weight loss + splenomegally
Pancytopenia and derranged LFTs =

A

Visceral leishmaniasis

128
Q

Diagnosis of PMR

A

Clinical -> give pred

129
Q

Common electrolyte abnormality in thyrotoxicosis

A

HyperCa

130
Q

Rapid correction of hyperNa -> ? Whats happening intracellularly?

A

Cerebral oedema due to gain of water

131
Q

Atherosclerosis which cells in tunica intima?

A

Macrophages

lipid laden foam cells

132
Q

DVT in preg Rx

A

LMWH

133
Q

Long term rate control in AF with cardiac failure

A

Bisoprolol

Digoxin worse mortality

134
Q

Lots of lifting - Carpal tunnel symptoms but also paraesthesia over palm

A

Pronator syndrome

carpal tunnel symptoms do not affect the palm, pronator syndrome will

Lesion is proximal to formation of sensory branch
They will also not get worsening of symptoms atnight unlike carpal tunnel

135
Q

Which enzyme transports free fatty acids into cell to use as energy?

A

carnitine acyltransferase

Carnivors eat lots of fat

136
Q

coarctation usually also have?

A

Bicuspid aortic valve - in 60%

137
Q

Ring enhancing lesions on CT. How to confirm Dx? Rx?

A

CSF PCR
Pyrimethamine and sulfadiazine

138
Q

Stab wound just lateral to sternum hits?

A

RV

LV if a couple cm lateral

139
Q

Wells score DVT - If 1 or less?
2 or more?

A

1 or less - D-dimer

2 or more - Doppler

140
Q

If doppler negative for DVT then what?

A

if doppler negative -> d dimer and if this is positive repeat the doppler after 6 days

141
Q

No freinds and not intersted in people and does not feel lonely? What if they were lonely?

A

Schitzoid

Avoidant if they are lonely

142
Q

Differentiate common peroneal and L5 lesion

A

Common peroneal has preserved foot inversion and plantar flexion

143
Q

Which post-mi heart failure drug might cause pancreatitis

A

Furosemide

144
Q

Carbamazepine mechanism

A

Inhibit voltage gated sodium channel

Think causes hypoNa (different mechaism but same electrolyte)

145
Q

Diabetes, gall stones, weight loss, dia/steatorrhoea, HypoCl

A

Somatostatinoma
From D cells

146
Q

BP med worsening psoriasis

A

B blockers

147
Q

Endocarditis - which bug has better outcomes

A

Strep - less resistance and better response to Abx

148
Q

Severe lung disease in A1AT which genotype

A

ZZ
[tired of trying to remeber these]

149
Q

Carribean
Intermittent confusion
Nodular skin rash, distal sensory deficit, thoracic anuerysm

A

Syphilis

syphilitic aneurysms occur in 90% of cases on the thoracic aorta

150
Q

Bar immunpsupression what other cause for poor antibody response to vaccines

A

HLA type

151
Q

Prolactinoma - drug class for Rx

A

Dopamine agonist
Eg bromocriptine, ropinorole, carbegoline

152
Q

Syringomyelia - where LMN signs? UMN?

A

LMN - upper limbs (reduced reflexes and wasting

UMN - Lower limbs - spaciticty

153
Q

Thumb to touch fingertips muscle?

A

Opponens pollicus

Opposition of thumb

153
Q

Thumb to touch fingertips muscle?

A

Opponens pollicus

Opposition of thumb

154
Q

2 Types of BP med that worsen myasthenia

A

BB / CCBs

155
Q

Cat scratch disease - usual Rx?

A

Conservative in immunocompetent

cipro/azithro if needed

156
Q

Cat scratch disease - usual Rx?

A

Conservative in immunocompetent

cipro/azithro if needed

157
Q

What causes finger drop in rheum A

A

Swelling of ulnar styloid
->rupture of tendon

Needs surgical repaire obvs

158
Q

Dosuleptin class

A

Tricyclic

159
Q

Recurrent myoglobinuria likely cause?

A

Cartinine palmitoyltransferase deficiency

160
Q

Gonnorrheoa Rx

A

IM cef + oral azithro

161
Q

Ph of normal pleural fluid?
Ph to suspect pleural fluid is malignant

A

7.6
under 7.3

162
Q

Icidental finding of pleural plaques on XR - what next

A

Nothing - likely asbestos but in absence of lung disease just leave them alone

163
Q

Surgical referral in endocardititis

A

Prolonged PR
ongoing Fevers after 5 days

164
Q

Neck pain
tongue deviates right
Right sided loss of vibration and proprioception
Left sided weakness

Where is lesion

A

Vertebral artery

165
Q

What stimulates bladder emptying? Overactive bladder drug class for Rx ?

A

Parasympathetic stimulation
Muscarinic antagonists

166
Q

Closure of urethral sphincter is from?

A

Sympathetic stimulation

opposite of bladder - want bladder contraction and urethral relaxion at the same time

167
Q

Malignant / asbestosis effusion 1st line Ix?

A

Pleural tap

168
Q

Tertiary hyperPTH when cinacalcet, when parathyroidectomy

A

Cinacalcet if surgery inappropriate

If young deffs surg

169
Q

Paracetamol OD INR for poor outcome

A

> 2 by 24hrs
3.5 by 72

> 6.5 is referral for liver Tx

170
Q

IVDU - now extensive palapable purpuric rash and distal motor weakness over months. What has happened ?

A

Cryoglobulinaemia secondary to HepC

171
Q

Lorazepam mechanism? When might it be used in pal care not for agitation?

A

GABA-A agonist
Nausea - enhances the effects of conventional antiemetics

172
Q

2 things prolonging life in MND

A

Riluzole
NIV

173
Q

Codine to morphine calculation

A

divide by 12
240mg codeine = 20mg morphine

MRCP PART 1 (22 decks)

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