Past papers Flashcards
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
What is seen on renal biopsy in HSP (IgA vasculitis)?
Mesangial deposition of IgA
What is the difference in serology between acute hepatitis B and false positive hepatitis B?
Acute - core IgM antibody
False positive - core IgG antibody
What blood tests are seen in Wilson’s disease?
Low caeruloplasmin
High serum, hepatic, and urinary copper
What are the characteristics of alopecia areata?
Non scaly discrete patches of hair loss
Increased association with atopic eczema
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
What is a risk of starting statins whilst patients are hypothyroid?
Increased risk of myalgia
What is the most common thyroid malignancy?
Papillary
What is an adverse effect of urate-lowering therapy?
Acute gout attacks
What is the source of bleeding in haemoptysis?
Bronchial artery in 90%
Pulmonary artery in 5%
When is serum C-peptide not useful?
In the absence of true hypoglycaemia
Define delayed haemolytic transfusion reaction
Occurs at least 24 hours after transfusion
Clinically evident by 2 weeks post transfusion
Why is flecainide avoided in LVSD or IHD?
Negatively inotropic
How is septic arthritis post joint injection diagnosed?
Blood cultures (more sensitive than synovial fluid culture)
What are the effects of cocaine?
Hyperthermia Chest pain Hypertension Agitation Arrhythmias Rhabdomyolysis
Where is the ulnar nerve commonly entraped?
At the elbow - medial epicondyle
Why is ABPI required in venous ulcers?
Compression bandaging is contra-indicated if there is insufficient arterial blood supply of the foot
What are the effects of systemic sclerosis on the bowel?
Small bowel bacterial overgrowth from reduced peristalsis and dilatation
Which drugs can cause lithium toxicity?
ACEIs
ARBs
Diuretics
What should be performed before CT scan in acute ulcerative colitis?
AXR to exclude toxic megacolon
What antibody is involved in hyperacute organ rejection?
IgG - as it is from pre-existing humoral immunity
What is the treatment of restless leg syndrome?
Mild: quinine
Mod-severe: ropinirole, pramiprexol, rotigotine
Describe the pupil of acute angle glaucome
Dilated
Non-reactive
What is the triad of Miller-Fisher syndrome?
Ataxia
Internal and external ophthalmoplegia
Arreflexia
Associated with antibodies to GQ1b
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?
3
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
