Past papers Flashcards by Lucy Searle

What are post-authorisation safety studies?

Observational studies conducted after clinical trials

Look at adverse effects in patients not studied e.g. pregnant women, children, liver and renal impairment

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What is seen on renal biopsy in HSP (IgA vasculitis)?

Mesangial deposition of IgA

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What is the difference in serology between acute hepatitis B and false positive hepatitis B?

Acute - core IgM antibody

False positive - core IgG antibody

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What blood tests are seen in Wilson’s disease?

Low caeruloplasmin

High serum, hepatic, and urinary copper

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What are the characteristics of alopecia areata?

Non scaly discrete patches of hair loss

Increased association with atopic eczema

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If urinary calcium is not high enough for thiazide diuretic therapy to prevent renal calculi, what is used?

Potassium citrate

Forms complexes with calcium ions

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What is a risk of starting statins whilst patients are hypothyroid?

Increased risk of myalgia

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What is the most common thyroid malignancy?

Papillary

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What is an adverse effect of urate-lowering therapy?

Acute gout attacks

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What is the source of bleeding in haemoptysis?

Bronchial artery in 90%

Pulmonary artery in 5%

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When is serum C-peptide not useful?

In the absence of true hypoglycaemia

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Define delayed haemolytic transfusion reaction

Occurs at least 24 hours after transfusion

Clinically evident by 2 weeks post transfusion

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Why is flecainide avoided in LVSD or IHD?

Negatively inotropic

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How is septic arthritis post joint injection diagnosed?

Blood cultures (more sensitive than synovial fluid culture)

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What are the effects of cocaine?

Hyperthermia
Chest pain
Hypertension
Agitation
Arrhythmias
Rhabdomyolysis

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Where is the ulnar nerve commonly entraped?

At the elbow - medial epicondyle

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Why is ABPI required in venous ulcers?

Compression bandaging is contra-indicated if there is insufficient arterial blood supply of the foot

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What are the effects of systemic sclerosis on the bowel?

Small bowel bacterial overgrowth from reduced peristalsis and dilatation

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Which drugs can cause lithium toxicity?

ACEIs
ARBs
Diuretics

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What should be performed before CT scan in acute ulcerative colitis?

AXR to exclude toxic megacolon

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What antibody is involved in hyperacute organ rejection?

IgG - as it is from pre-existing humoral immunity

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What is the treatment of restless leg syndrome?

Mild: quinine

Mod-severe: ropinirole, pramiprexol, rotigotine

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Describe the pupil of acute angle glaucome

Dilated

Non-reactive

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What is the triad of Miller-Fisher syndrome?

Ataxia
Internal and external ophthalmoplegia
Arreflexia

Associated with antibodies to GQ1b

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What happens to the RAAS system in CCF?

Pathologically activated due to decreased renal perfusion pressure Leading to high levels of aldosterone, angiotensin, renin

What are the joint crystals in gout and pseudo gout?

Gout: needle shaped, negative birefringence Pseudo: rhomboid shaped, positive birefringence

What organism colonises indwelling lines?

Staph epidermis

What is a side effect of quinolones?

Tendon rupture

What investigation is diagnostic of acromegaly?

Growth hormone suppression test

How do thiazide diuretics cause hypokalaemia?

Increased loss in the distal tubule | Sodium ions are exchanged for potassium and H+ ions

How many anti-retroviral drugs are used for PEP?

What is the most common cause of viral gastroenteritis?

Norovirus

What does BRCA code for?

DNA repair protein (tumour suppressor gene)

What is a common method of analysis in RCTs?

Intention to treat

What is the most common cause of myocardial infarction in pregnancy?

Coronary artery dissection

What parameters does the waterlow score use?

``` Continence Age Sex Body weight Nutritional status Skin type Mobility ```

What is the initial treatment of erythrodermic psoriasis?

White soft paraffin | Until systemic treatment is initiated

What drug can precipitate generalised pustular psoriasis?

Prednisolone

What does the SMA supply?

Distal duodenum to 2/3 the way across transverse colon

How does intense exercise cause amenorrhoea?

Hypothalamus secretes less GnRH

What is anacrotic pulse?

Slow rising pulse seen in aortic stenosis

What kind of pulse is found in cardiac tamponade?

Pulsus paradoxus

What are the risk factors for completed suicide?

Older age Male Use of alcohol (to a lesser extent)

In patients taking morphine with renal impairment, what accumulates?

Morphine 6-glucuronide

What is the mechanism of action of isosorbide mononitrate?

Increases cGMP - nitric oxide donor | Mediates the vasodilatory effects of nitrates

What blood test results suggest autoimmune hepatitis?

Raised IgG | ALT>AST >1 (favours autoimmune/viral over alcoholic)

What is seen in posterior MI?

ST depression and dominant R wave V1-V3

What supplies the posterior surface of the heart?

85% - posterior descending | 15% - circumflex (left dominant circulation)

What would occlusion in the first septal branch of the LAD lead to?

STE in I and aVL alone

What is the treatment of toxic thyroid adenoma?

Radioiodine

When is prednisolone indicated in hyperthyroidism?

Thyroiditis

How to calculate serum osmolality?

2Na + 2K + glucose + urea

What is the treatment of overactive bladder?

Anti-muscarinic drug such as oxybutynin or solifenacin

When are hydralazine and isosorbide mononitrate started in heart failure?

3rd line - often started together Hydralazine - arterial vasodilator, isosorbide - venodilator Often if BP is high

What are the indications of ivabradine in heart failure?

Often IHD EF<35% HR >75bpm

What is the mechanism of action of haloperidol?

D2 receptor antagonist | Binds to receptors in area postrema (medullary structure controlling vomiting)

Anaphylactic allergy to penicillin means avoidance of which antibiotics?

Beta-lactams | Includes penicillins, meropenem, cephalosporins

What is the mechanism of hypophosphataemia in refeeding syndrome?

Intracellular shift

What cardiac diseases are important in pregnancy?

Stenotic valvular lesions (regurgitant lesions well tolerated) Pulmonary hypertension R to L cardiac shunt

What is the cause of torticollis?

Contracture of the contralateral sternocleidomastoid muscle

What is the most common cause of epiglottitis?

Haemophilus influenzae

Which infection can mimic Crohn's disease/appendicitis by causing mesenteric adenitis?

Yersinia enterocolitica

How are bone marrow metastases diagnosed?

Pancytopenia | Blood film shows leukoerythroblastic infiltration e.g. nucleated red blood cells, myelocytes, metamyelocytes

Where are the site of lesions causing a fixed eye palsy?

Frontal lobe | Eyes look towards lesion

Which drugs characteristically cause tremor?

``` Lithium Valproate Tacrolimus/ciclosporin Thalidomide/cytarabine Theophylline ```

What is aneuploidy?

Abnormal number of chromosomes

What type of biopsy is done in Hodgkin lymphoma?

Excision | Fine needle likely to yield insufficient material

What isotype of ANA are associated with lupus?

IgG

What is meningococcal meningitis prophylaxis for close contacts?

Ciprofloxacin