Past Papers Flashcards
What is associated with poor prognosis in RA?
Anti CCP antibody
Pure sensory neuropathy - diagnosis?
Uraemic neuropathy
Not GBS as no motor involvement
What is the mechanism of action of irinotecan?
Topoisomerase inhibitor
Multiple cranial nerve palsies - where is the lesion?
Cavernous sinus
What exhibits zero order kinetics?
Aspirin - salicylates
Congruous vs incongruous quadrantopias
CRIT
Congruous - radiations
Incongruous - tract
Urine findings in acute tubular necrosis (2)
High urine osmolality
High urine sodium - tubules unable to reabsorb
Where are parietal cells found?
Fundus of stomach
What is the precursor to endogenous NO?
L-arginine
NO then causes an increase in cGMP
What drug is associated with IUGR
Bisoprolol (B blockers)
Jaundice
Ascites
Weight gain
Sudden onset
Differential?
Veno-occlusive event in liver e.g. Budd Chiari
Management of nephrogenic DI secondary to lithium
Use thiazide diuretic, reduces the urine output
Precursor to cortisol
11 deoxycortisol
Basal meningeal enhancement + bacterial CSF
TB meningitis
Concern with TEN
VTE - fluid loss, resulting hyperviscosity
Horner’s syndrome
- course of neurones
1st order - hypothalamus to cervical spine
2nd order - runs along sympathetic chain to superior cervical ganglion
3rd order - superior cervical ganglion to cavernous sinus (via internal carotid artery)
Genotype in severe A1-antitrypsin deficiency
PiZZ
Management of botulism
Anti-toxin
Management of cyanide poisoning
Amyl nitrate
What is tobramycin an example of?
Aminoglycoside (30s subunit inhibition)
Management of active lupus disease + renal involvement
MMF better than HCQ
Management of hip osteonecrosis + young patient
Decompression and grafting
THR as a last resort
What is fear of germs?
Mysophobia
Management of nausea in bowel obstruction
Haloperidol
Grapefruit juice is a…
CYP3A4 inhibitor
Reduces metabolism - greater toxicity effect of medication
What is the pathogenesis of serotonin syndrome?
Impaired serotonin reuptake
Diagnosis of MND
Electromyography is helpful
Management of persistent air leak in PTX
Video guided thorascopic pleurodesis
Talc pleurodesis most helpful in malignancy
Fixed S2 - ostium secundum vs ostium primum
Ostium secundum is more common
Both cause fixed S2
Number needed to treat?
1/
control event rate - experimental event rate
How do B cells switch which immunoglobulins they produce?
Switch the constant heavy chain region
What is the risk of celecoxib?
Less risk of GI haemorrhage than other NSAIDs
Risk of worsening cardiac failure
1st line management in ADPKD
ACEI
Rapid reversal of warfarin e.g. urgent surgery
PCC - offers more rapid reversal than vitamin K
Gene association with
- breast/pancreatic/prostate cancer
BRAC2
(BRAC1 not pancreatic cancer as much)
What is the pathophysiology of haemoptysis in
- bronchiectasis
- PE
Bronchiectasis = capillary engorgement
PE = pulmonary parenchyma necrosis
Assessment of function post stroke
Barthel Index
Does Bart need hel(p) following his stroke?
What measure of lung function is reduced in obesity?
ERV
Feature in CKD that contributes to iron deficiency anaemia
Increased hepcidin
= hepcidin reduces oral iron absorption
Anti-hypertensive to avoid in lithium use
ACEI/ARB - can increase lithium toxicity
1st line anti-HTN in pregnancy
Labetalol
(nifedipine is second line)
Vomiting - determining between bulimia and anorexia
Bulimia - if BMI >17.5
If below that = anorexia
Type of receptor
- insulin
Tyrosine kinase
What has the greatest influence on O2 inspiration?
Flow rate of O2 (think HFNC - doesn’t matter about the mask, all about the flow)
Management of pericarditis
Colchicine
Anakinra
Pericardectomy
Non reactive pupil
Occular muscles intact
What is painful?
= microvascular cause
If painful consider posterior communicating aneurysm
Investigation for confirmation of renal artery stenosis
MR angiography
Idiopathic pulmonary hypertension classification
Group 1
What in management of pulmonary hypertension can reduce sperm count?
Endothelin receptor antagonist
What gallbladder stones are people with sickle cell prone to?
e.g. sickle cell or hereditary spherocytosis
= chronic haemolysis
= bile pigment stones due to increased bilirubin
Management of erythroderma in psoriasis
Ciclosporin
Bronchiolitis obliterans
- lung function pattern
- symptom
Obstructive
Breathlessness
Determining bone involvement in myeloma
Whole body MRI
Management of lewy body dementia
Donezepil
- poor response to levodopa
How do fibrates reduce cholesterol?
They reduce intestinal cholesterol absorption
What is needed for the diagnosis of amoebiasis?
Hot poo - sample taken within 15 mins to the lap
Statistical test for crossover trial
Paired T test
Colon cancer + no polyps at young age =
= HNPCC
MSH2 gene
Which anti-epileptic is associated with visual field defects?
Vigabatrin
What testicular tumour is associated with hCG?
Teratoma
Viral CSF sample + low glucose =
= mumps meningitis
Mechanism of action of Orlistat
= inhibits pancreatic lipase to prevent absorption of fat
Investigating ARMD
Fluorescein angiography
What supplies the first web space?
Radial nerve (superficial branch)
Reversed split S2
Loud S1
Palpitations
= WPW Type B
- RV accessory pathway results in early RV excitation and depolarisation = early P2
= widely split reversed S2
What do you need to monitor in GBS?
Vital capacity
= ask the patient to count to 10 in one breath
What is the first line medication for acute schizophrenia?
Risperidone
What is the trinucleotide repeat in Huntington’s disease?
CAG repeat
Unilateral optic neuropathy
Proximal myopathy
Telengiectasia
- inheritance
Leber’s Hereditary Optic Neuropathy
- mitochondrial inheritance
Management of retinopathy near the macula
Focal retinal photocoagulation
- want to prioritise and save the macula
Management of aortic root dilation in Marfan’s syndrome
ARB
What is the metabolite of morphine which results in respiratory depression and nausea?
Morphine-6-glucoronide
What are those with IgG2 deficiency susceptible to?
Haemophilus influenzae
When in the cell cycle does vincristine act?
Metaphase
- interrupts tubule formation
Raynaud’s
Vibration
Sensory loss
Hand arm vibration syndrome
- sensory loss is the key, not seen in RP
How does alcohol cause hypoglycaemia?
= increased blood flow to pancreas, increased endocrine pancreatic function
= increased insulin production
Psychosis/paranoia
+ depression
= schizoaffective disorder
What is heard in ASD?
Wide split S2
- also increased blood flow over tricuspid valve
Biphasic fever from abroad
Dengue
Long QT syndrome mutation
K+ alpha subunit - K+ channels
Management of Barrett’s oesophagus
Radiofrequency ablation
Management of UC flare
- no response to steroids despite 72 hours
Ciclosporin
Scleritis vs Episcleritis
Scleritis = SCREAMing in PAIN
Positive predictive value =
= how well test can identify true positives vs false positives
Abnormal sensation > motor activity > seizure
- where is the problem?
Right parietal lobe
Valve abnormality seen in pulmonary hypertension
Tricuspid regurgitation
(similar to MR in severe LV failure)
What controls plantarflexion?
Gastrocnemius
Management of listeria
Amoxicillin + gentamicin
Consideration/avoid with febuxostat
Avoid in cardiac disease
- use colchicine if unable/no response to allopurinol
What cardiac abnormality is associated with ankylosing spondylitis?
Aortic regurgitation
What VHL has the greatest risk of phaeochromocytoma and renal cell carcinoma?
VHL Type 2B
Anti-topoisomerase 1 antibodies =
= anti-Scl 70 antibodies
Two biochemical features of Child Pugh score
Bilirubin >52
INR >2.3
Which anti-epileptics are safe in pregnancy?
L-L
lamotrigine + levetiracetam
What is the genetic inheritance of alpha anti-1 trypsin deficiency?
Autosomal co-dominant
Component of staghorn calculus
Struvite (magnesium ammonium phosphate calculus)
Schistomiasis with lung/liver involvement
- which type involved?
S. japonicum
Management of membranous nephropathy
Prednisolone + cyclophosphamide
OR
Rituximab
What is the approximate rates of pancreatic tumours in MEN1?
Gastrinoma - 60%
Insulinoma - 30%
Management of urge incontinence
- Bladder retraining
- Oxybutynin OR tolteradine
- Mirabegron - frail, want to avoid anti-cholinergics
Management of stress incontinence
- Pelvic floor training
- Duloxetine
Relative risk =
intervention rate group - control rate group /control rate group
Bifascicular block + EF <30%
Consider CRT
Ipsilateral 3rd nerve palsy + contralateral hemiplegia =
= Weber’s syndrome
Amyloid in chronic inflammatory disorders e.g. RA
AA amyloid
Gitelman’s
- gene affected
- channel affected
- biochemical results (3)
SLC12A3
Na/Cl transporter channel
= hypokalaemia, high bicarbonate, hypocalciuria
Exclamation hairs are seen in…
Alopecia areata
How can you differentiate between acute and chronic renal failure on blood tests?
= PTH
- high in chronic renal failure (to compensate for hypocalcaemia)
Mechanism of action of rasburicase?
Urate oxidation
EBV - how long to avoid contact sports?
4 weeks
What must you use with caution in severe aortic stenosis?
B blockers - may worsen syncope (remember LV is trying to overcome the gradient)
Statistical test to compare 2 means?
ANOVA
Which anti-tuberculous drug is associated with increased steroid requirement?
Rifampicin - inducer = more rapid metabolism, need more steroid
Recent subarachnoid
Headache + confusion
Diagnosis?
Hydrocephalus
What anti-psychotic should you avoid in movement disorders
e.g. Parkinson’s disorder
Risperidone
Reticulocytes VS erythrocytes
= reticular staining
Reticulocytes do NOT have a nucleus
What can you use to treat itching in liver failure?
Cholestyramine
What type of receptor is the nicotinic receptor?
Acetylcholine receptor
1st line management of HOCM and LVOT obstruction
Bisoprolol
2nd = verapamil or disopyramide
What is the recurrent laryngeal nerve closely related?
Inferior thyroid artery
Subtypes of lupus nephritis
- which is the most common?
Membranous = nephritic syndrome, usually normotensive, normalish renal function
Diffuse = associated with poor renal function
Advanced sclerotic = ESRF
What can you use for carcinoid syndrome not responding to octreotide?
Teloristat (blocks serotonin production from tryptophan)
First management of acute hepatitis B infection
Usually observe and repeat PCR - likely to resolve
Poor prognostic factor in paracetamol OD
Low BMI
Poorly controlled HIV
Oesophageal ulcers
- diagnosis
- management
- what can be used as prophylaxis?
= CMV
Valganiclovir - also used as prophylaxis
Rule for mixed overdose
Never just treat one isolated item
Try and obtain an ECG
Mechanism of cisplatin
Causes DNA crosslinking
Mechanism of action of central pontine myelinosis
Rapid water efflux out of neurones
= loss of myelin
Actions of Vitamin D (4)
Increased absorption of calcium and phosphate from gut
Decreased PTH release
Osteoclast activation
Decreased TH1 response
Inferior ST elevation - which artery and region affected?
Distal RCA
- proximal RCA would result in spread to the anterior leads
1st line management in rosacea
Topical invermectin OR metronidazole (pregnant)
Brugada Syndrome
- genetic problem
- presentation
Mutations in sodium channels
VF usually at night (rather than exercise association)
Tall female
Nil axillary or pubic hair
Primary amenorrhoea
Androgen insensitivity syndrome
- XY genotype, female phenotype
Raised triglycerides and LDL =
Familial combined hypercholesterolaemia
Drugs associated with acute pancreatitis (6)
Sodium valproate
Loop diuretics
Tetracyclines
Oestrogens
Steroids
Octreotide
Management of serotonin syndrome
Cyproheptadine
Avascular necrosis in the foot - which bone usually affected?
2nd metatarsal head - tortuous blood supply
Management of impetigo
Mupirocin
OR fucidin
Pancreatic Insufficiency
- vitamin supplement
Vitamin A, D, E and K
Deficiency of alpha-galactoside
- condition
- inheritance
= Fabry’s disorder
X-linked recessive
Measure for survival time
Hazards ratio
Management of magnesium sulphate toxicity
Calcium gluconate
Polymyositis
Lung fibrosis
Rhabdomyolysis
- diagnosis
- pathophysiology of renal failure
Anti-Jo 1 syndrome
ATN due to rhabdomyolysis
Management of Behcet’s
Prednisolone where there is eye involvement
What is the effect of carbon monoxide on ventilation and inspiration?
Has no effect
ECG signs of left ventricular aneurysm
ST elevation in V1-V3
ECG signs of ischaemic cardiomyopathy
Poor R wave progression
LBBB
Conversion of PO to SC morphine
1/2 the oral dose
Management of pulmonary hypertension in pregnancy
Stop dual endothelin receptor antagonist e.g. bosentan
Start LMWH as prophylaxis
What cells are responsible for immune memory?
T cells
What is responsible for draining the oesophagus?
Azygous vein - upper 2/3rds
Management of dermatomyositis
Prednisolone
If not responsive trial azathioprine
Biochemical picture in Addison’s disease
Hyperkalaemic metabolic acidosis
Mechanism of action of baclofen
inhibits glutamate release
What is at risk of injury when close to the right recurrent laryngeal nerve?
Right thyroid artery
Management of hypocalcaemia/hyperphosphataemia in CKD
1st line - calcium acetate
Which is associated with pulmonary haemorrhage - EGPA or GPA?
GPA - so raised transfer factor
MND - two tests for prognosis
FVC
Sniff nasal inspiratory pressure
1st management of spontaneous bacterial peritonitis
IV antibiotics
Wouldn’t do ascitic drain
Rapid virilisation
Rapid onset puberty
Weight gain
Adrenal tumour
What mineral often needs supplementing following gastric bypass surgery?
Zinc
Sequence of events leading to T2DM
Ectopic fat deposition
Insulin resistance
B-cell failure
Management of coronary artery vasospasm
Calcium channel blocker e.g. amlodipine
Liddle VS Barter VS Gitelman
Liddle - hypertension, hypokalaemia, epithelial sodium channels
Barter’s - hypokalaemia, Na/K+/Cl- cotransporter
Gitelman - hypokalaemia, hypocalciuria
Na/Cl- thiazide sensitive channel
Syndrome associated with breast, endometrial, thyroid and colon cancer
- genetic mutation
Cowden’s syndrome
PTEN
CV defect in Noonan’s Syndrome
Pulmonary Stenosis
Management of Tourette’s Syndrome
Psychoeducation
Clonidine
Risperidone
Screening for haemochromatosis
General - transferrin saturation
Family - HFE genetic testing
What is associated with TB management and drug induced lupus?
Isoniazid
What activates macrophages?
INF-gamma
What stage of mitosis does vincristine act on?
Metaphase
Disinhibition
Gambling
Increased sweet tooth
Frontotemporal Dementia
Grave’s Disease VS TMN on scintigraphy
Graves = uniform uptake
TMN = patchy uptake
Where are SGLT2 channels?
EARLY proximal convoluted tubule
Basophilic stippling is seen in….
Lead poisoning
Sideroblastic anaemia
B thalassaemia trait
Isolated lymphocytosis
Smudge cells
- What is the diagnosis?
- What is the management?
CLL
FCR chemotherapy
= fludarabine, cyclophosphamide, rituximab
Management of severe alcoholic hepatitis
Steroids
What is the pattern in Brown-Sequard syndrome?
Contralateral temperature loss
(spinothalamic tract decusates at each level)
Ipsilateral loss of proprioception, vibration sense, spastic paresis
Management of high altitude cerebral oedema
Descent + dexamethasone
What does troponin I bind to?
actIn
(troponin C = calcium ions, troponin T = tropomyosin)
What causes chancroid?
What is the presentation?
Haemophilus ducreyi
= do CRY about pain (painful lesion), usually travel history
Investigation of choice for reflux nephropathy
Micturating cystogram
What is the toxic product in paracetamol overdose?
NAPQI
= n acetyl p benzoquinonemine
Young male
Arthralgia
Abdominal pain
Fever
Pericardial Effusion
Familial Mediterranean Fever
Odds Ratio - how to calculate?
Did: Didn’t
VS
Did: Didn’t
Specificity =
specifically negative
(negative + false positive)
Sensitivity =
they are sensitive so it’s important to be positive
Think celebrity is in love with them
De Clerambault’s syndrome
What is associated with T1 cyroglobulinaemia?
Raynaud’s phenomenon
Membranoproliferative GN - common to all cryoglobulinaemias
Side effect associated with sulphonylureas?
Example
Weight gain
Tolbutamide
Management of OCD
Exposure response therapy
Management options for vasodilator NEGATIVE pulmonary hypertension
PDE5 inhibitor e.g. sildenafil
Dual endothelin receptor antagonist e.g. bosentan
Prostacyclin analogues
Biochemical abnormality seen in Cushing’s Syndrome
Hypokalaemic metabolic alkalosis
- think there is XS aldosterone = K+ loss, alkalosis
Features associated with pancreatic cancer (2)
Double duct sign
Migratory thrombophlebitis
What movement is reduced in adhesive capsulitis?
External rotation
Which renal tubular acidosis is associated with renal stones?
T1 RTA
= too little acid in urine, alkaline urine, means that calcium and phosphate clump together = stones
Phosphate abnormality in 1y hyperparathyroidism
- why?
Low phosphate
Reduced absorption/increased excretion of phosphate in proximal tubule
Mechanism of action of pilocarpine
Muscarinic agonist
Management of pulseless VT or VF - initial
Unsynchronised DC shock (nothing to synchronise to)
What does the Golgi do?
Adds mannose 6-phosphate
What is the first choice anti-depressant in ischaemic heart disease?
Sertraline
How do you monitor haemochromatosis?
Ferritin
COPD
- where will they see benefit in NIV?
If pH is 7.25-7.35
Syringomyelia
- which tracts affected and where?
Spinothalamic tract - because they decussate at the anterior white commissure
What immunodeficiency predisposes to SLE?
C1q, C1rs, C2 and C4
Sudden painless loss of vision
Multiple retinal haemorrhages
Diagnosis?
Central retinal vein occlusion
Which cells in stomach secrete stomach acid (and so gastrin acts on)?
Parietal cells
HLA loci associated with RA
HLA DRB1
What technique is used for oncogene detection?
PCR
