Past papers Flashcards
Management for ethylene glycol overdose
Fomepizole
Burkitt’s lymphoma karyotype
T8:14
What is the mode of inheritance and defect of Alport’s syndrome
X-linked dominant type IV collagen
Screening for PKD
USS
47-year-old female with a history of rheumatoid arthritis presents with a painful and red left eye
Scleritis
Churg-Strauss syndrome serololgy
+ pANCA
85-year-old lady presents to dermatology clinic complaining of itchy white plaques affecting her vulva and inner thigh
Lichen sclerosus
Marfan’s syndrome is caused by a mutation in protein?
fibrillin-1
Angiodysplasia is associated with which murmur?
Aortic stenosis
Which TB medication can cause lupus?
Isoniazid
Which organelle is responsible for the catabolism of long chain fatty acids?
Peroxisome
Dermatitis herpetiformis is associated with
HLA-DR3
Which cell surface marker is associated with Reed-Sternberg cells?
CD15
What is the mechanism of cyanide toxicity?
Inhibits the mitochondrial enzyme cytochrome c oxidase
myocardial territory is most likely to have been affected if heart block develops post MI
inferior
Which phase in the cycle is influenced by p53 and determines the cell cycle length?
G1
Congenital adrenal hyperplasia is most commonly due to?
21-hydroxylase deficiency
What is the first-line long term therapy to reduce the occurrence of sickle cell indicents
Hydroxycarbamide
Bilateral spastic paresis and loss of pain and temperature sensation, what is affected
Anterior spinal artery syndrome1
1st line management in aspirin overdose
activated charcoal within 1 hr
Triangle of safety for chest drain insertion
Superiorly: base of the axilla.
Inferiorly: 5th intercostal space or level of the nipple.
Anteriorly: lateral edge of pectoralis major.
Posteriorly: anterior border of latissimus dorsi.
Chlamydia psittaci is treated with
tetracyclines
The fastest conduction velocities in the heart are in the
Purkinje fibres
Functional residual capacity =
Expiratory reserve volume + Residual volume
Meningococcal meningitis prophylaxis for contacts
Oral cipro
management to reduce the likelihood of haemorrhagic cystitis in non-Hodgkins pt receiving cyclophosphamide
Hydration + mesna
most common and severe form of renal disease in SLE patients
Diffuse proliferative glomerulonephritis
Where do SGLT-2 inhibitors work?
renal proximal convoluted tubule
Which oncogene is associated with Burkitt’s lymphoma?
c-MYC
Management of severe alcoholic hepatitis
Pred
Antidiuretic hormone action
water reabsorption by the insertion of aquaporin-2 channels
28-year-old man painful gential ulcers, diagnosis and asscioated organism
Chancroid
Haemophilus ducreyi
How is Cryptosporidium diagnosed
Ziehl-Neelsen staining of stool to reveal red cysts
Local anesthetic toxicity can be treated with
IV 20% lipid emulsion
Pan-systolic murmur which is best heard at the end of inspiration
Murmur and associated JVP change
Tricuspid regurg
Prominent V waves
Reflux nephropathy investgation
Micturating cystography
calcium, phosphate and PTH unaffected with ALP raised
Diagnosis and management
Pagets
zoledronate
low calcium and low phosphate with increased ALP and increased PTH.
Diagnosis & risk factor
osteomalacia
vegetarian
tenosynovitis, migratory polyarthritis, dermatitis
Diagnosis
Disseminated gonococcal infectio
Unilateral Flashes + floaters
diagnosis
posterior vitreous detachment
Which phase does vincristine act during
metaphase
Which spinal columns are affected in subacute combined degeneration of the spinal cord,
dorsal columns and lateral corticospinal tracts
Which part of the kidney is most affected in nephrogenic DI
Vasopressin receptor
Bisphosphonate action
inhibit osteoclasts
AF on warfarin with ICH, management
Vit K and prothrombin complex
Suspicious freckle on face or scalp of chronically sun-exposed patients
pigmented and rapidly changing
Lentigo maligna melanoma
Thyrotoxic storm management
beta blockers, propylthiouracil and hydrocortisone
How do you differentiate between chronic myeloid leukaemia from leukaemoid reactions
leukocyte alkaline phosphatase score is low in CML, high in leukaemoid reaction
The time taken for an arteriovenous fistula to develop is
6-8 weeks
Cushing’s syndrome VBG
Hypokalaemic metabolic alkalosis
Brain abscess management
IV Cefotaxime and metronidazole
Where is phosphate reabsorbed
proximal tubule
A high vaginal swab is performed and microscopy reveals stippled vaginal epithelial cells and the whiff test is positive.
Diagnosis and organism
BV
Gardnerella vaginalis
worse on resisted wrist extension/suppination whilst elbow extended
Lateral epicondylitis
management of eosinophilic oesophagitis
Dietary modification and topical steroids
Peripheral blood film findings in coeliac
Target cells and Howell-Jolly bodies
Metastatic bone cancer pain management
MST + refer for radiotherapy
Poor prognostic factors in AML
A age more than 60
M myeloblast more than 20% (> 20% blasts after first course of chemo)
L cytogenetic location : deletions of chromosome 5 or 7 (Acute = 5 letters , myeloid = 7 letters )
Thyrotoxicosis with tender goitre
De Quervain’s thyroiditis
Which glomerulonephritis is most associated with Goodpasture’s syndrome?
Rapidly progressive glomerulonephritis
treatment of choice for allergic bronchopulmonary aspergillosis
PO glucocorticoids
Which meds cause toxicity due to zero order elimination
There is zero order in a HEAP
Heparin
Ethanol
Aspirin
Phenytoin
Which group of medications are associated with increased mortality in dementia patients
Anti-psychotics
Which meds cause photosensitive rash
SAT for a PHOTO:
Sulphonamides/Sulphonylureas/pSoralens/Siprofloxacin
Amiodarone/nsAids
Tetracycline/Thiazides
What is raised in acute intermittent porphyria
urinary porphobilinogen
42-year-old woman with pseudoxanthoma elasticum which conditions is she at risk of
mitral valve prolapse and ischaemic heart disease
32-year-old female 3-week history of a mild rash on her face very sensitive to the sunlight two months postpartum
Diagnosis and mangement
Acne rosacea
Topical metronidazole/PO tetracycline
Which structure may overlie the L renal hilum
Tail of pancreas
Why can alcohol cause hypoglycaemia
Increased first phase insulin response
HOCM inheritance pattern
Autosomal dom
42 female with SLE, presents with dry eyes
Diagnosis and +Ve antibodies
Sjorens
Anti-Ro and Anti La
27 male, night sweats, weight loss, gential ulcers, arthralgia, red itch eyes
diagnosis and management
Bechets (uveitis, oral and gential ulcers)
Pred
46 female, HTN, T2DM
swollen hands/fingers and increasing size of jaw
investigation and diagnosis
IGF1 - raised
Glucose tolerance test with GH measurements (GH >1)
acromegaly
wasting of thenar eminence , reduced sentation over 2nd and 3rd fingertips
nerve affected and condition
distal median nerve
carpal tunnel
loss of sensation over dorsal and radial portion of hand, dorsal thumb and dorsal index finger, motor intact
nerve affected
distal radial
History of CVD, sudden unilateral deterioration in vision
pale retina on fundoscopy
CRAO
Police officer bitten by human, broken skin and blood drawn
Management
Co-amox if <72h
Likely organism to colonate platelet transfusion
staph epidermidis
19 male, struggles to form relationships, tall, thin, sparse pubic hair, bilateral gynaecomastia
Diagnosis and chromosomes
Klienfelter
XXY
18 male, prolonged bleeding following tooth extraction, sister had similar thing
Diagnosis and inheritance and prophylaxis
VWD
autosomal dom
desmopression prior to procedures
Test for infectious TB
Multiple sputum smear and culture
Marfans Murmur
pulmonary regurg
Lyme disease management
doxy
19 male
atopic eczema, admitted with multiple itchy pustules, fever
Diagnosis and management
eczema herpaticum
IV aciclovir
DRB1 *04:01 *04:04 *10 *01:10
RA
Loss of proprioception and vibration, upgoing plantars, optic neuritis
Vit B12 def
smoker
bilateral lower limb weakness with increased tone and hyperreflexia
Conus medallaris
Digoxin MOA
Intracellular Na accumulation - inhibits sodium potassium exchange pump
male, unprotected sex in India, single painless ulcer on penis + lymphadenopathy
Diagnosis and management
Lymphogranuloma Venereum
Doxy
60 male returning from convention in Portugal, fever, joint/muscle pain, diarrhoea
Diagnosis and managment
Legionnaires disease
Levo
Diabetic retinopathy, has received full scatter pan-retinal photocoagulation, which visual defects may he have
tunnel vision
reduced colour
impaired contract sensitivity
45 returned from Russia, coryzal symptoms followed by fever , severe sore throat and nose bleeds. grey/white membrane over pharyngeal tissue
diagnosis and management
Diptheria
azithromycin
20 male, no PMH, sudden onset palps whilst drinking
ECHO normal
ECG shows new AF
Haemodynamically stable
Management
Flecanide
Amaurosis fugax artery affected
internal carotid
How frequently should you monitor bloods in stable diabetic
6 months
Poor prognostic factors in PPH
Elevated BNP
Developing AF
70 male sudden onset vomiting, vertigo and R sided Horners , L sided loss of pain/temp in torso and limbs
Diagnosis
R PICA
Phosphate reabsorption
prox tubule
Management of persistent ascites in liver pts
spiro
19 female, syncope, muscle cramps and tiredness
hypokalaemia
high bicarb
high urine calcium
diagnosis and management
Bartter syndrome
K+ replacement
Calcium oxelate stone managemetn
thiazide diuretic
Abnormal resp test in obesity
exp reserve volume
25, UC
rapidly growing ulcerated lesion on shin with necrotic centre
diagnosis and management
pyoderma gangrenosum
PO pred
61 female, HTN, DM
sore throat, rash and mouth ulcers, conjunctivitis
diagnosis
Steven Johnson syndrome
Acute promyelocytic leukaemia management
all-trans retinoic acid
Blood test following acute allergic reaction
trypase
Gene associated with breast, prostate and pancreatic ca
BRCA2
45 male
weight gain, HTN, acne, elevated fasting glucose
diagnosis and investigation
24h cortisol
Cushings
Causes of exudate and transudate effusion
exudate: malig and infection
transudate: failures
Which human leukocyte antigen is associated with psoriasis
B27
management of rocacea
1st: top metrondiazole
top azeliac acid
PO doxy
23 T1DM
syncope, N&V, hyponatraemia, hypoglycaemia
Investigations and diagnosis
synacthen test ?adrenal insuf
Neck spasm and fixed gaze following metaclopramide
diagnosis and management
oculogyric crisis
benztropine (anticholingeric)
Which cancers is HPV 16 associated with?
Cervical
Oropharnygeal
anal
penile
mid systolic click followed by late systolic murmur, loudest at apex
mitral valve prolapse
Neuro consequence of Nitrous oxide use
low b12 -> subacute combined degen of spinal cord
impared motor, proprio, fine touch
Pathophysio of haemoptysis in bronchiectasis
capillary engorgement
Which deficiency causes loose teeth and gum disease in alcoholics
Vit C
Most likely site of gastrin producing tumour
pancreas
What is the reason for transfusing irridated blood?
avoid graft versus host disease
Blood film: neutrophils with bilobed nucleia
hereditary pelger huet
Antibodies seen in primary biliary cholangitis?
anti-mitochondrial
amitriptylline OD
GCS 10, short runs of VT QRS 115
Initial management
Sodium bicarb
meningitis, gram + diplococci
management
strep pneumoniae
ceftriaxone and vanc
meningitis gram -ve diplococci
Organism and management
Neisseria
ceftriaxone
Where are the cells affected by gent toxicity located?
Prox tubule
Eczema management
Top corticosteroids or tacrolimus
PO ciclosporin, azathioprine, mycophenalate
-mab or -nib
which receptor found on biospy determines response trastuzumab
HER2
dilated pupil which doesnt react to light
diagnosis
3rd nerve palsy
MODY management
gliclazide (sulphonylureas)
HLA associated with Bechets
B51
HIV pt with lesions in mouth on arms and legs
diagnosis and organism
Kaposi sarcoma
human herpes virus 8
where is most sodium reabsorbed
PCT and asending loop of henle
male, difficultly forming relationships, no sense of smell, small testes sparse pubic hair
diagnosis, management
Kallmann syndrome
Testosterone or GnRH
Management of pituitary adenoma
Bromocriptine
1cm ulcerated lesion with necrotic centre
diagnosis
SCC
Female with rheumatoid, presents after prolonged nose bleed, ATPP prolonged
diagnosis and pathophysiology
acquired haemophilia A, factor VIII inhibition
second heart sound + diastolic murmur
ASD
pins and needles 4th and 5th fingers
wasting of muscles in hypothenar eminance
cubital tunnel syndrome
testicular teratoma tumour marker
alpha fetoprotein
45 male, increasing weight, T2DM, HTN ?diagnosis and investigation
24h urinary cortisol ?cushings
Management of diabetes in cystic fibrosis patients
insulin
UC maintenance remission
PO mesalazine
71, itch, raised Hb low erythropoietin, splenomegaly
diagnosis and genetics
primary polycythaemia
JAK 2 +Ve
LFT raised which would indicate hepatic vs cholestatic condition
2 x ALT - hepatic
2 x ALP - cholestatic
seizure involving tongue chewing, mouth and tongue movements and limb jerking
area
parietal lobe
SLE antibodies and which Ig
ANA
IgG
PPH murmur
tricuspid regurg
42 female, works on farm, PMH asthma, worsening asthma
CXR: bilateral shadowing
diagnosis
allergic bronchopulmonary aspergilliosis
23 male, 2 weeks following unprotected sex, dysuria, conjunctivitis, olioarthritis
organism and diagnosis
Chlamydia trachomatis
- reactive arthritis
Post glandular fever
Extreme fatigue, SOBOE, bruising Hb/ WCC/platelets low
investigation and diagnosis
Bone marrow aspirate
Aplastic anaemia
Elderly patient
Large tense blisters on flexor surfaces sparing mucous membranes
Bullous pemphigoid
Mangement of bowel spasms
Mebeverdine
HNPCC increased cancer risk
endometrial
Ank spon murmur
Aortic regurg
- early diastolic
Management of listeria meningitis
amox and gent
loss of night and peripheral vision
spicules on retina
Retinitis pigmentosa
24 years old
HTN and high creatinine and +protein on urine dip
Recurrent UTIs as a child
US shows scarring on L kidney
diagnosis
reflux nephropathy
Lithium overdose management
haemodialysis
HIV test 4 weeks post infection
HIV 1 RNA
P24 max specific at 3.5 weeks so could have false -ve
Ank spon imaging and management
MRI
adalimumab
Variceal bleed prophylaxis
carvedilol
anti-epileptics safe in pregnancy
lamotrigene and keprra
25 male, HTN, headaches and palpitations
investigations and diagnosis
24h urinary catecholamines
phaeochromacytosis
Which form of haemaglobin is raised in Beta thalasseamia
HbA2
Idiopathic membranous glomerulonephritis management
rixitumab
Staghorn caniculi
magnesium ammonium phosphate stones
farmer, red papule on finger increasing in size
diagnosis and management
parapox virus - orf
mostly self limiting but if persist cryotherapy or cidoovir cream
+++ exposure to TB +ve patient testing
Mantoux test
dilated pupil that reacts slowly to light but brisk to accomodation
Holmes Addie
vaccine CI with egg allergy
yellow fever
29 female, prolactin secreting tumour and hyperparathyroidism, sister and dad have the same
diagnosis and other ca at risk
MEN type 1
gastrinoma
19 jaundice sclera, splenomegaly, brother has anaemia
anaemia with spherocytes on film
investigation and diagnosis
cryohaemolysis and eosin-5-maleimide binding tests
hereditary spherocytosis
HIV patient
seizure
multiple ring enhancing lesions on MRI
CNS toxoplasmosis
Sudden onset right hemiplegia and 3rd nerve palsy
posterior cerebral artery infarct
signs of cardiac tamponade
SOB
tachycardia
elevated JVP
45 male, increasing falls, upper limp weakness, weakness in hands, increased tone in hands, fasciculations
investigation and diagnosis
MRI Whole spine
?MND
How long to avoid contact sport following EBV with splenomegaly
4 weeks
MRI: atrophy of temporal and parietal lobes
diagnosis and management
Alzheimers
Donepenzil
Common mets to bone primary
-breast
-prostate
-lung
What cardiac med should be use with caution in severe aortic stenosis
beta blockers
Which antibody is most specific for rheumatoid arthritis
anti CCP
cals required
25-35/kg/day
severe pulmonary stenosis on JVP
increased a waves
obesity management
- lifestyle
- liraglutide
- gastric band
psychotic symptoms in parkinsons disease
clozapine
LBBB signs
reverse splitting of s2
GI symptoms after drinking water on holiday
Giardiasis
Diabetic med with increased risk of hypoglycaemia
gliclazide
Carconoid syndrome mangement
Ocetrotide
telotristat
Smoking cessation safe in pregnany
NRT
HIV +ve
pain when swallowing, ulcers in lower and middle third of oesophagus
diagnosis and management
CMV infection
valganciclovir
cerebral venous thrombosis mangement
LMWH
N&V 3 hours after eating out, likely organism
staph aureus
3 days post MI
SOB, hypotensive bilateral crackles
likely diagnosis
acute MR
Initial investigation in ?CLL
Immunophenotyping
1st line glaucoma management
IOP >24 : laser
otherwise
lantoprost
timolol
- pilocarpine
Peripheral sensory and motor neuropathy in pt with macrocytic anaemia
B12 def
Findings on US with diabetic nephropathy
GBM thickening
mesangial expansion
arteriolar hyalinosis
Urinary Na in SIADH
> 20
cat scratch organism
bartonella henselae
Cervical HPV association
HPA 18
restless leg syndrome management
ropinirole
Cell type that produce IgE
B cells
SBP management
IV Cef
72 male, short term memory loss, visual hallucinations, shuffling gate, increased tone left side, bilateral tremor L>R
Diagnosis and management
Lewy Body dementia
Donepezil
31 male, ex heroin addict, arthralgia, rash with palpable purpura pain in fingers/toes and blue discolouration for 3 months
diagnosis
hep C
34 female, laughing inappropriately, difficulty finding words, missing words when speaking
diagnosis
lesion in dominant frontal lobe - Brocas area
55 admitted with fever and rash, recent course of co-amox
reduction in renal function
interstitual nephritis
liver transplant on tacrolimus, given clari for infection
expected symptoms and why
N&V, low Hb, platelets, high Cr and K+
clari is CYP3A4 inhib and tacro is metabolised by CYP3A4 = accumulation of tacro
melanocyte pigmentation around mouth, multiple hamartomatous polps on colonoscopy
Mum and sister have breast ca
Peutz Jeghers syndrome
Hypotension and bradycardia post PCI to LAD
STE with ventricular escape rhythm
mangement
CHB
atropine
pacing
Anaphylaxis to blood product deficiency and measures to be taken in future transfusions
IgA
Washed RBC
D&V multiple people on cruise ship
norovirus
incontinence and increased frequency with enlarged smooth prostate management
finasteride
doxazosin
family history cardiac arrest whilst asleep
Brugada
marfans sudden onset blurred vision
upwards lens dislocation
headache and inability to open right eye
pupil deviated down and right
diagnosis
post comm artery aneurysm
anti-psychotic CI parkinsons
haloperidol
HOCM signs
forceful apex beat
late systolic murmur augmented by valsalva
management serotonin syndrome
cyproheptadine
IVDU large groin abscess, face grimace, neck stiffness, muscle spasms
diagnosis and management
tetanus
human tetanus immunoglobulin
Which cardiac med worsens psoriasis
bisoprolol
Where does indapamide act
distal tubule
erythematous crusting lesions on side of chin satellite areas of erythema, itchy
impetigo
top mupirocin
threadworm treatment
mebendazole
infection risks post splenectomy
strep pneumonia
h influenza
n mening
alcoholic, ataxic gait
where is damaged
cerebellar vermis
Which parkinsons meds do not increase gambling risk
procyclidine
CA 125
ovarian
CA 19-9
pancreatic
Ca 15-3
Breast
AFP
teratoma
hepatocellular
CEA
colorectal
S-100
melanoma, schawannoma
Bombesin
small cell lung cancer, gastric cancer
neuroblastoma
17 male, rash swollen joints, haematuria
high cr, normal culture and US KUB
diagnosis and expected biopsy result
IgA vasculitis
Mesangial deposition of IgA
pupils accommodate but do not react and are typically bilaterally small.
Argyll Robertson
ptosis with ipsilateral small pupil
Horners
ipsilateral ptosis and pupillary enlargement.
3rd cranial nerve palsy
Previous thyroidectomy - elevated Cholesterol, TSH high T4 normal
management
Levothyroxine
Most common thyroid malignancy
Papillary thyroid carcinoma
adolescent female has cervical and mediastinal lymphadenopathy
Hodgkins lymphoma
Likely source of bleeding with severe haemoptysis
bronchial and pulmonary arteries
A 47-year-old man presented with a 6-month history of episodic sweating and hunger. He had gained 10 kg in weight and drank 10 units of alcohol per week. borderline low fasting glucose
Test and diagnosis
plasma glucose concentration following a prolonged (72-h) fast
?insulinoma
pain in his right elbow and tingling in the medial aspect of his right hand. His job involved using a sledgehammer.
lateral epicondylitis
- ulnar nerve
42 male UC
cholestatic bloods
primary sclerosing cholangitis
A 50-year-old man presented with a 24-hour history of agitation, confusion and suicidal thoughts. He had started VAD chemotherapy (vincristine, doxorubicin and dexamethasone) 4 days previously, following a diagnosis of multiple myeloma. Diagnosis
corticosteroid psychosis
traumatic hemisection of his spinal cord at T10 level.
What is most likely to be present below the level of the lesion 2 months after the injury?
contralateral loss of pain and temperature sensation
Which immunoglobulin is responsible for hyperacute rejection
IgG
Management restless leg syndrome
ropinirole
needlestick injury from recently diagnosed HIV pt.
hepatitis C negative and vaccinated against hepatitis B virus
What is the most appropriate post-exposure prophylaxis for the doctor?
three-drug antiretroviral treatment for 1 month
What is the normal function of BRCA1?
tumour suppression
CSF high protein, low glucose and lymphocytosis
listeria
CSF very high protein, low glucose and lymphocytosis
TB
CSF high protein, low glucose (<50% plasma), and a very high neutrophil count.
Neisseria meningitides and Streptococcus pneumoniae
22 year old MI post partum
coronary artery dissection
mild left-sided ptosis. Her left pupil was larger than her right and reacted poorly to light (direct and consensual). There was loss of pinprick sensation on her right forehead.
What is the most likely site of the lesion?
left cavernous sinus
common SE tacrolimus
tremor
What is the mechanism of action of ropinirole?
dopamine receptor agonist
