Past Papers Flashcards
Womanly man, small balls, libido lacking?
Any mention of male with sparse pubic hair, gynaecomastia and small testes also
Kleinfelters
Acute MI after stenting and stopping clopidogrel? Re-stenosis or in-stent thrombosis?
In-stent thrombosis
Re-stenosis takes much longer
Sounds like cauda equina with lower limb weakness but INCREASED tone?
Conus medularis syndrome
Concurrent single genital ulcer with lymphadenopathy?
LV
(Shyphilis lymphadenopathy presents later)
Antibiotic preference in legionella
Modern quinolone e.g. levofloxacin
Macrolides are an alternative
Side effects of retinal photocoagulation?
Tunnel vision, colour loss
Acute onset AF, no heart disease?
Flecanaide
Earliest helpful investigation in RA (imaging)
Colour doppler
Where is phosphate reabsorbed?
Proximal tubule
PPH poor prognostic factors
Raised BNP
Arrhythmia
RHF/hypertrophy
Largest component of bile?
Bile salts
Which part of the kidney is impermeable to water?
Ascending loop of henle
Long term bronchiectasis/chronic inflammatory condition and then develops kidney failure?
Think amyloid
Blistering skin condition in the sun in an alcoholic, often with raised AST/ALT and ferritin?
PCT
Thyroid cancer much higher risk in hashimotos patients?
Lymphoma
First line for schitstosomiasis?
Praziquentel
Best treatment of worsening lupus nephritis?
MFM
TB drug most commonly assoc with eye disease?
Ethambutol
Mild genotype in A1AT?
MZ
Therapy of choice in anti-GMB renal disease?
Cyclophosphamide
Where is the ostium of the coronary sinus?
RA
Small bowel angiodysplasia and heart murmur?
Heyde’s disease - AS
Frontal lobe stroke symptoms?
Distal anterior cerebral artery
Fluconazole and verapamil together and constipation
FLuconazole may have increased serum verapamil and caused it
Vomiting 7-8hrs post rice?
Bacillus ceres
Occular tumour in VHL?
Hemangioblastoma
Ciclosporin action?
Anti-IL-2
Hormone under constant feedback?
Prolactin
Schistosoma mansoni and haematobium, which assoc with bladder Ca and which with hepatic fibrosis?
Haematobium bladder Ca - (bladder Ca bleeds (haem))
Pupil in syphilis?
Argyll Robertson
usually bilateral
Mention of shawl-like distribution of sensory loss?
Syringomyelia
What time is cortisol lowest?
0000
First line treatment for WPW (non-acutely)
Ablation
Massive uric acid levels despite either allopurinol or fexobustat?
Add benzbromarone
Cyclophosphamide action
Anti-Tcell
Ambrisentan mechanism?
Endothelin B antagonist
What can be added in psoriatic arthritis after MTX and another DMARD?
ANti-TNF e.g. golimumab/infliximab/adalimumab/etanercept
Renal biopsy in GPA?
Pauci immune!
Hasnt tried continuous HRT, or is within 2 years of last period?
Sequential HRT
Hyperkalaemic metabolic acidosis with worsening of potassium on ACEi?
RTA type 4
Gonorrhoea and penicillin allergy?
High dose azithromycin once off
Neglect mentioned? Which lobe affected and which side
Contralateral parietal lobe
How do you prevent stones in someone with medullary sponge kidney?
Large fluid intake
What is a 7th nerve palsy? Treatment?
Bells
Steroids
Single thyroid nodule (symptomatic) in woman with completed family and older children?
Radioiodine
Paget’s treatment
IV!!! bisphosphonates
Soil contamination wound?
Clindamycin
Eye changes in NFM?
Lisch nodules
What do microRNAs do?
Silence mRNA
What often drops with IV quinine treatment for malaria?
Glucose
Schistosomiasis treatment?
Praziquantel
Short fourth and fifth metacarpals?
Pseudohypoparathyroidism
Herceptin (trastuzumab) major adverse effect?
Cardiac failure
Deletions assoc with poor prognosis in CLL?
17q
p53
Genetic features assoc with better prognosis in CLL?
13q
Trisomy 12
Treatment for Waldenstrom’s?
Rituximab-containing chemo regime
(if you see a chemo plus rituximab it’s that)
Most sensitive area in response to hypoxia?
Carotid body
Earliest detectable test for HIV infection?
RNA
Osmolality equation?
(2 x Na) + (2 x K) + urea + glucose
Bacteria often found in dog bites
Pasturella
Endovascular coil or neurosurgical clipping preferred in intracranial aneurysm?
Coil
Live vaccines?
Yellow fever
BCG
MMR
Influenza
VZV
Long term prevention for cluster headaches?
Verapamil
Thinking pathway for AV replacement?
If fit, either mechanical or bioprosthetic valve. If a contraindication to anticoagulation - bioprosthetic.
If not fit for surgery - TAVI.
Treatment for cyclosporidium?
Co-trim
Antibiotic treatment in culture negative peritonitis?
Intraperitoneal vanc plus oral cipro
What can you give to protect the bones in a Turners patient?
HRT
First line preventative measure in congenital long QT?
BB
First and second line for reactive arthritis?
NSAIDs
Then steroids
What to add to SU in MODY if needs further intervention?
Insulin, usually long acting in first instance
Aspirin mechanism?
COX 1 AND COX 2
Immunotherapy in Grave’s eye disease?
Tocilizumab
APML gene?
15:17
MODY with renal cysts?
MODY-5
First line in JME?
When might you want to use something else and what would you use?
Valproate
Older girls - risk to a foetus. Leviteracitam istead
Prominent x and y descents?
Restrictive disease
Most prone side of the heart for healthy individuals?
Left side (high pressure)
Right side in IVDU
Young man with progressive unilateral optic neuropathy, eventually other eye involvement, +/- proximal muscle features and increased tone?
Leber’s hereditary optic myopathy
How long off driving after ICD shock?
6 months
When to check lithium level after starting?
5-7 days
Where most affected in Wilson’s?
Basal ganglia
von Willebrand chromosome?
12
Depression with significant somnolence?
Venlafaxine
Main treatment for ank spon?
Adalibumab
Antifreeze antidote?
Fomepizole
Most common GI cause of GBS?
Campylobacter
Vaginal flora mostly made up of?
Lactobacilli
Crossed neurological signs after stroke? Lesion must be in the …
Brainstem
Best test of respiratory muscle weakness in GBS?
FVC
Dense fibrous tissue replacing the thyroid?
Riedel’s
HIV nephropathy type
COLLAPSING (like the immune system)
Gallop rhythm an early sign of?
LVH
SGLT2 location of action?
Early proximal tubule
Most specific finding in pericarditis?
PR depression
AML good prognosis genetic finding?
t15:17 (APML)
Negative predictive value equation?
TN / (TN + FN)
(think all the negatives, comparing the actual negatives with all the negative results)
Most common endocarditis organism? What if within 2 months of replacement?
Staph aureus
Staph epidermis
Goodspastures and ANCA GNs, which type?
Rapidly progressive
First line treatment for ABPA?
Steroids
What inhibits prolactin?
Dopamine
What is contralateral in Brown-Sequard?
pain and temperature loss
What’s high in PCT?
What about AIP?
Urine UROporphyrinogen
Urine PORphobilinogen
What produces IL-1?
Macrophages
What does troponin I bind to?
Actin
Phenytoin mode of metabolism? What else uses this?
Zero-order
Alcohol, salicylates
Most common photosensitivity drug cause?
Thiazides
What is inserted in response to ADH?
Aquaporin-2 channels
Chancroid microbial
H. ducreyi
Cryptosporidium test?
ZN stain on stool
TR change in JVP waveform?
Prominent V waves
Anti-NMDA cancer assoc?
Ovarian teratoma
Type 1 and 2 cryo, assoc with what?
Type 1 - Monoclonal IgG/IgM diseases, lymphoproliferative syndromes
Type 2 - AI disease/ IDs. Polyclonal IgGs/IgM
Good stuff for cancer oral pain?
Benzydamine mouthwash
Toxin in paracetamol overdose?
NAPQI
First line for rosacea?
Topical metronidazole
Sensitivity equation?
TP / TP+FN
Most commonly affected gene in congenital nephrogenic DI?
Vasopressin
Second most Aquaporin 2
Burkitts gene
8:14
Tear drop cells?
Myelofibrosis - think of marrow trying to squeeze cells out of dry marrow
Earliest XR change in RA?
Juxta-articular osteoporosis/osteopenia
Renal transplant + infection, think…
CMV
S4 coincides with?
P wave
Thinking toxoplasmosis but only one lesion and homogenously enhancing?
CNS lymphoma
Barters vs Liddles vs Gitelmans
All hypokalaemic
Liddles causes
Barters HIGH calcium (Big C)
Gitelmans causes LOW calcium (Gone C) and LOW magnesium
Alports inheritance?
X-linked dominant
Itchy white spots on the vulva of old woman?
Lichen sclerosus
Idiopathic MG antibody?
APLA2
TB drug induced lupus?
Isoniazid
Goodpastures collagen type?
4
Dermatitis herpetiformis HLA association?
HLA - DR3
CD on Reed-Sternberg cells?
CD15
What should you give in cocaine induced MI alongside ACS Rx?
IV benzos
Drug causing corneal opacities?
Amiodarone
Somatostatin produced where?
D cells
Which stage of cell cycle dictates the length? (p53 acts on this part)
G1
Most common cause of CAH?
21-hydroxylase def
Pityriasis rosea implicated virus?
Herpes 7
Whats wrong in Fanconi syndrome?
Global lack of resorptive defect in PROXIMAL tubule
Triangle of safety borders?
Lateral pec major
5th intercostal space in axilla
Anterior border of latissimus dorsi
Brugada gene?
SCN5A
Widening of the wrist joints?
Rickets
Microtubule function?
Help guide movement during intracellular transport and also help bind internal organelles
Hyperthyroid and patchy gland uptake?
Toxic multinodular goitre
Mucopigmentation and polyps/GI cancer?
Peutz-Jeghers
Where does RNA splicing happen?
Nucleus
ADAMTS13?
TTP
Inf STEMI?
RCA
Range of inherited heart diseases but the deaths appear while sleeping/overnight?
Brugada
Furosemide primarily reduces preload or afterload?
Preload
Achondroplasia inheritance?
AD
3 steps of haemoglobin metabolism
Haem -> biliverdin -> bilirubin
IV therapy in serotonin syndrome?
Cyproheptadine
Young woman, perhaps sportsperson, pain swelling of forefoot?
AVN of 2nd metatarsal head (Freibergs)
If duchenne and becker both options in the question, how to separate?
DMD far more severe, similar features
Impetigo first line?
Topical mupirocin/fucidin
Alports what is abnormal?
T4 collagen
Bad antibiotic in AIP?
Erythromycin
What can you not drink with a statin?
Grapefruit juice
Threadworn treatment
Mebendazole
Drug-induced lupus autoantibody?
Anti-histone
Initial PD therapy if trying to avoid dopamine-agonist SEs e.g. gambling?
Procyclidine
Anti-LKM2?
AI hepatitis
Drug-induced hepatitis
Calcineurin inhibitors target?
IL-2
Chronic psoriasis HLA?
CW6
RA treatment and pancytopenia and terrible renal impairment?
d-penicillamine
Purely a winging of the scapula, what is injured?
Long thoracic nerve
Young person with bad sounding presentation/B symptoms and nephrotic syndrome?
Minimal change
Ondansetron mechanism?
5-HT3 antagonist
Percentage of patients whose renal function will recover after dialysis for ATN?
95%
Biggest type of bias problem in meta-analysis?
Publication
Psychotic features in PD? Try
Olanzapine
Itching in liver failure?
Cholestyramine
HNPCC mutation?
MSH2 (no polyps, just cancer)
First line treatment of acute hep B in a well person?
Observe and repeat testing
Upper GI ulcers in HIV?
Think CMV - valganciclovir
Want to compare outcomes from two groups of decent size and with normal distribution?
Students t-test
Ipsilateral CNIII palsy and contralateral hemiplegia? Which artery
Weber syndrome (middle medullary sydrome)
Posterior cerebral artery (leads to midbrain infarcation)
Very useful endocrine blood test to differentiate between acute and chronic renal failure?
PTH
Normal implies acute disease with 90% confidence
What first before surgery for macroprolactinoma?
Cabergoline
What is the resistance in factor V leiden?
Protein C
First test for MND?
EMG
Rasburicase mechanism?
Recombinant urate oxidase
Guideline for contact sports post EBV?
4 weeks
Comparing two proportions? Which two tests? Which is more accurate?
Fisher - very complex but significantly more accurate
Chi-squared
Comparing two large groups with skewed distribution?
Mann-Whitney
ARVT causing anaemia?
Zidovudine
Why can ETOH cause hypoglycaemia?
Increased insulin generation
Most common SBP organism?
E coli
Nasty sounding lesion described at the margin of a chronic venous ulcer?
SCC
Description of mixed depressive and schizophrenic-like periods?
Schizoaffective disorder
BRCA1 & 2 cancers?
Breast
Ovarian
Pancreas
Prostate
Autoimmune disease, triggered bleeding and massively prolonged APTT?
Think acquired haemophilia A
AED safe in heart block?
Primidone
Travel, unwell, salmon-pink rash?
Typhoid
Travel, appalling muscle/bone pains, very high fever?
Dengue
Which subunit in most common long QT?
Alpha
Testicular teratoma marker?
AFP
Anti TB peripheral neuropathy?
Isoniazid
Evanicumab
ANGPTL3
Good initial intervention for mania?
Risperidone
Crossed neurological signs so thinking brainstem lesion, describes lateral rectus (abducens) palsy?
Medial pontine syndrome (medial pons)
First line DMARD in eczema/psoriasis?
Ciclosporin
What do we like to give for cardioprotection in marfans?
Beta blocker, if not ARB e.g. valsartan
Where do foam cells originate?
Neutrophils
Haloperidol location of action?
D2-receptor antagonist. It has a central antiemetic action, binding to receptors in the area postrema
ISMN actioon?
Cyclic GMP
