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1MRCP Part 1 > Past Papers > Flashcards

Past Papers Flashcards

1
Q

What is associated with poor prognosis in RA?

A

Anti CCP antibody

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2
Q

Pure sensory neuropathy - diagnosis?

A

Uraemic neuropathy
Not GBS as no motor involvement

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3
Q

What is the mechanism of action of irinotecan?

A

Topoisomerase inhibitor

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4
Q

Multiple cranial nerve palsies - where is the lesion?

A

Cavernous sinus

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5
Q

What exhibits zero order kinetics?

A

Aspirin - salicylates

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6
Q

Congruous vs incongruous quadrantopias

A

CRIT
Congruous - radiations
Incongruous - tract

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7
Q

Urine findings in acute tubular necrosis (2)

A

High urine osmolality
High urine sodium - tubules unable to reabsorb

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8
Q

Where are parietal cells found?

A

Fundus of stomach

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9
Q

What is the precursor to endogenous NO?

A

L-arginine
NO then causes an increase in cGMP

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10
Q

What drug is associated with IUGR

A

Bisoprolol (B blockers)

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11
Q

Jaundice
Ascites
Weight gain
Sudden onset
Differential?

A

Veno-occlusive event in liver e.g. Budd Chiari

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12
Q

Management of nephrogenic DI secondary to lithium

A

Use thiazide diuretic, reduces the urine output

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13
Q

Precursor to cortisol

A

11 deoxycortisol

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13
Q

Basal meningeal enhancement + bacterial CSF

A

TB meningitis

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13
Q

Concern with TEN

A

VTE - fluid loss, resulting hyperviscosity

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13
Q

Horner’s syndrome
- course of neurones

A

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)

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14
Q

Genotype in severe A1-antitrypsin deficiency

A

PiZZ

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14
Q

Management of botulism

A

Anti-toxin

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14
Q

Management of cyanide poisoning

A

Amyl nitrate

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15
Q

What is tobramycin an example of?

A

Aminoglycoside (30s subunit inhibition)

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15
Q

Management of active lupus disease + renal involvement

A

MMF better than HCQ

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15
Q

Management of hip osteonecrosis + young patient

A

Decompression and grafting
THR as a last resort

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15
Q
A
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16
Q

What is fear of germs?

A

Mysophobia

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16
Q

Management of nausea in bowel obstruction

A

Haloperidol

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17
Q

Grapefruit juice is a…

A

CYP3A4 inhibitor
Reduces metabolism - greater toxicity effect of medication

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17
Q

What is the pathogenesis of serotonin syndrome?

A

Impaired serotonin reuptake

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17
Q

Diagnosis of MND

A

Electromyography is helpful

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17
Q

Management of persistent air leak in PTX

A

Video guided thorascopic pleurodesis
Talc pleurodesis most helpful in malignancy

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17
Q

Fixed S2 - ostium secundum vs ostium primum

A

Ostium secundum is more common
Both cause fixed S2

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17
Q

Number needed to treat?

A

1/
control event rate - experimental event rate

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17
Q

How do B cells switch which immunoglobulins they produce?

A

Switch the constant heavy chain region

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17
Q

What is the risk of celecoxib?

A

Less risk of GI haemorrhage than other NSAIDs
Risk of worsening cardiac failure

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17
Q

1st line management in ADPKD

A

ACEI

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17
Q

Rapid reversal of warfarin e.g. urgent surgery

A

PCC - offers more rapid reversal than vitamin K

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17
Q

Gene association with
- breast/pancreatic/prostate cancer

A

BRAC2
(BRAC1 not pancreatic cancer as much)

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18
Q

What is the pathophysiology of haemoptysis in
- bronchiectasis
- PE

A

Bronchiectasis = capillary engorgement
PE = pulmonary parenchyma necrosis

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18
Q

Assessment of function post stroke

A

Barthel Index
Does Bart need hel(p) following his stroke?

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18
Q

What measure of lung function is reduced in obesity?

A

ERV

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18
Q

Feature in CKD that contributes to iron deficiency anaemia

A

Increased hepcidin
= hepcidin reduces oral iron absorption

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18
Q

Anti-hypertensive to avoid in lithium use

A

ACEI/ARB - can increase lithium toxicity

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18
Q

1st line anti-HTN in pregnancy

A

Labetalol
(nifedipine is second line)

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18
Q

Vomiting - determining between bulimia and anorexia

A

Bulimia - if BMI >17.5
If below that = anorexia

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18
Q

Type of receptor
- insulin

A

Tyrosine kinase

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18
Q

What has the greatest influence on O2 inspiration?

A

Flow rate of O2 (think HFNC - doesn’t matter about the mask, all about the flow)

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18
Q

Management of pericarditis

A

Colchicine
Anakinra
Pericardectomy

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18
Q

Non reactive pupil
Occular muscles intact
What is painful?

A

= microvascular cause
If painful consider posterior communicating aneurysm

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18
Q

Investigation for confirmation of renal artery stenosis

A

MR angiography

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18
Q

Idiopathic pulmonary hypertension classification

A

Group 1

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18
Q

What in management of pulmonary hypertension can reduce sperm count?

A

Endothelin receptor antagonist

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19
Q

What gallbladder stones are people with sickle cell prone to?

A

e.g. sickle cell or hereditary spherocytosis
= chronic haemolysis
= bile pigment stones due to increased bilirubin

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19
Q

Management of erythroderma in psoriasis

A

Ciclosporin

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19
Q

Bronchiolitis obliterans
- lung function pattern
- symptom

A

Obstructive
Breathlessness

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19
Q

Determining bone involvement in myeloma

A

Whole body MRI

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19
Q

Management of lewy body dementia

A

Donezepil
- poor response to levodopa

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19
Q

How do fibrates reduce cholesterol?

A

They reduce intestinal cholesterol absorption

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19
Q

What is needed for the diagnosis of amoebiasis?

A

Hot poo - sample taken within 15 mins to the lap

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19
Q

Statistical test for crossover trial

A

Paired T test

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19
Q

Colon cancer + no polyps at young age =

A

= HNPCC
MSH2 gene

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19
Q

Which anti-epileptic is associated with visual field defects?

A

Vigabatrin

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19
Q

What testicular tumour is associated with hCG?

A

Teratoma

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19
Q

Viral CSF sample + low glucose =

A

= mumps meningitis

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19
Q

Mechanism of action of Orlistat

A

= inhibits pancreatic lipase to prevent absorption of fat

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20
Q

Investigating ARMD

A

Fluorescein angiography

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20
Q

What supplies the first web space?

A

Radial nerve (superficial branch)

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20
Q

Reversed split S2
Loud S1
Palpitations

A

= WPW Type B
- RV accessory pathway results in early RV excitation and depolarisation = early P2
= widely split reversed S2

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20
Q

What do you need to monitor in GBS?

A

Vital capacity
= ask the patient to count to 10 in one breath

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20
Q

What is the first line medication for acute schizophrenia?

A

Risperidone

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20
Q

What is the trinucleotide repeat in Huntington’s disease?

A

CAG repeat

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20
Q

Unilateral optic neuropathy
Proximal myopathy
Telengiectasia
- inheritance

A

Leber’s Hereditary Optic Neuropathy
- mitochondrial inheritance

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20
Q

Management of retinopathy near the macula

A

Focal retinal photocoagulation
- want to prioritise and save the macula

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21
Q

Management of aortic root dilation in Marfan’s syndrome

A

ARB

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21
Q

What is the metabolite of morphine which results in respiratory depression and nausea?

A

Morphine-6-glucoronide

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21
Q

What are those with IgG2 deficiency susceptible to?

A

Haemophilus influenzae

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21
Q

When in the cell cycle does vincristine act?

A

Metaphase
- interrupts tubule formation

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21
Q

Raynaud’s
Vibration
Sensory loss

A

Hand arm vibration syndrome
- sensory loss is the key, not seen in RP

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21
Q

How does alcohol cause hypoglycaemia?

A

= increased blood flow to pancreas, increased endocrine pancreatic function
= increased insulin production

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22
Q

Psychosis/paranoia
+ depression

A

= schizoaffective disorder

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23
Q

What is heard in ASD?

A

Wide split S2
- also increased blood flow over tricuspid valve

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24
Q

Biphasic fever from abroad

A

Dengue

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25
Q

Long QT syndrome mutation

A

K+ alpha subunit - K+ channels

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26
Q

Management of Barrett’s oesophagus

A

Radiofrequency ablation

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27
Q

Management of UC flare
- no response to steroids despite 72 hours

A

Ciclosporin

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27
Q

Scleritis vs Episcleritis

A

Scleritis = SCREAMing in PAIN

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28
Q

Positive predictive value =

A

= how well test can identify true positives vs false positives

29
Q

Abnormal sensation > motor activity > seizure
- where is the problem?

A

Right parietal lobe

30
Q

Valve abnormality seen in pulmonary hypertension

A

Tricuspid regurgitation
(similar to MR in severe LV failure)

31
Q

What controls plantarflexion?

A

Gastrocnemius

31
Q

Management of listeria

A

Amoxicillin + gentamicin

32
Q

Consideration/avoid with febuxostat

A

Avoid in cardiac disease
- use colchicine if unable/no response to allopurinol

33
Q

What cardiac abnormality is associated with ankylosing spondylitis?

A

Aortic regurgitation

34
Q

What VHL has the greatest risk of phaeochromocytoma and renal cell carcinoma?

A

VHL Type 2B

35
Q

Anti-topoisomerase 1 antibodies =

A

= anti-Scl 70 antibodies

36
Q

Two biochemical features of Child Pugh score

A

Bilirubin >52
INR >2.3

37
Q

Which anti-epileptics are safe in pregnancy?

A

L-L
lamotrigine + levetiracetam

38
Q

What is the genetic inheritance of alpha anti-1 trypsin deficiency?

A

Autosomal co-dominant

39
Q

Component of staghorn calculus

A

Struvite (magnesium ammonium phosphate calculus)

40
Q

Schistomiasis with lung/liver involvement
- which type involved?

A

S. japonicum

41
Q

Management of membranous nephropathy

A

Prednisolone + cyclophosphamide
OR
Rituximab

42
Q

What is the approximate rates of pancreatic tumours in MEN1?

A

Gastrinoma - 60%
Insulinoma - 30%

43
Q

Management of urge incontinence

A
  1. Bladder retraining
  2. Oxybutynin OR tolteradine
  3. Mirabegron - frail, want to avoid anti-cholinergics
44
Q

Management of stress incontinence

A
  1. Pelvic floor training
  2. Duloxetine
45
Q

Relative risk =

A

intervention rate group - control rate group /control rate group

46
Q

Bifascicular block + EF <30%

A

Consider CRT

47
Q

Ipsilateral 3rd nerve palsy + contralateral hemiplegia =

A

= Weber’s syndrome

47
Q

Amyloid in chronic inflammatory disorders e.g. RA

A

AA amyloid

48
Q

Gitelman’s
- gene affected
- channel affected
- biochemical results (3)

A

SLC12A3
Na/Cl transporter channel
= hypokalaemia, high bicarbonate, hypocalciuria

49
Q

Exclamation hairs are seen in…

A

Alopecia areata

50
Q

How can you differentiate between acute and chronic renal failure on blood tests?

A

= PTH
- high in chronic renal failure (to compensate for hypocalcaemia)

51
Q

Mechanism of action of rasburicase?

A

Urate oxidation

52
Q

EBV - how long to avoid contact sports?

A

4 weeks

53
Q

What must you use with caution in severe aortic stenosis?

A

B blockers - may worsen syncope (remember LV is trying to overcome the gradient)

54
Q

Statistical test to compare 2 means?

A

ANOVA

54
Q

Which anti-tuberculous drug is associated with increased steroid requirement?

A

Rifampicin - inducer = more rapid metabolism, need more steroid

55
Q

Recent subarachnoid
Headache + confusion
Diagnosis?

A

Hydrocephalus

56
Q

What anti-psychotic should you avoid in movement disorders
e.g. Parkinson’s disorder

A

Risperidone

57
Q

Reticulocytes VS erythrocytes

A

= reticular staining
Reticulocytes do NOT have a nucleus

58
Q

What can you use to treat itching in liver failure?

A

Cholestyramine

59
Q

What type of receptor is the nicotinic receptor?

A

Acetylcholine receptor

60
Q

1st line management of HOCM and LVOT obstruction

A

Bisoprolol
2nd = verapamil or disopyramide

61
Q

What is the recurrent laryngeal nerve closely related?

A

Inferior thyroid artery

62
Q

Subtypes of lupus nephritis
- which is the most common?

A

Membranous = nephritic syndrome, usually normotensive, normalish renal function
Diffuse = associated with poor renal function
Advanced sclerotic = ESRF

63
Q

What can you use for carcinoid syndrome not responding to octreotide?

A

Teloristat (blocks serotonin production from tryptophan)

64
Q

First management of acute hepatitis B infection

A

Usually observe and repeat PCR - likely to resolve

65
Q

Poor prognostic factor in paracetamol OD

A

Low BMI

66
Q

Poorly controlled HIV
Oesophageal ulcers
- diagnosis
- management
- what can be used as prophylaxis?

A

= CMV
Valganiclovir - also used as prophylaxis

67
Q

Rule for mixed overdose

A

Never just treat one isolated item
Try and obtain an ECG

68
Q

Mechanism of cisplatin

A

Causes DNA crosslinking

69
Q

Mechanism of action of central pontine myelinosis

A

Rapid water efflux out of neurones
= loss of myelin

70
Q

Actions of Vitamin D (4)

A

Increased absorption of calcium and phosphate from gut
Decreased PTH release
Osteoclast activation
Decreased TH1 response

71
Q

Inferior ST elevation - which artery and region affected?

A

Distal RCA
- proximal RCA would result in spread to the anterior leads

72
Q

1st line management in rosacea

A

Topical invermectin OR metronidazole (pregnant)

73
Q

Brugada Syndrome
- genetic problem
- presentation

A

Mutations in sodium channels
VF usually at night (rather than exercise association)

74
Q

Tall female
Nil axillary or pubic hair
Primary amenorrhoea

A

Androgen insensitivity syndrome
- XY genotype, female phenotype

75
Q

Raised triglycerides and LDL =

A

Familial combined hypercholesterolaemia

76
Q

Drugs associated with acute pancreatitis (6)

A

Sodium valproate
Loop diuretics
Tetracyclines
Oestrogens
Steroids
Octreotide

77
Q

Management of serotonin syndrome

A

Cyproheptadine

78
Q

Avascular necrosis in the foot - which bone usually affected?

A

2nd metatarsal head - tortuous blood supply

79
Q

Management of impetigo

A

Mupirocin
OR fucidin

80
Q

Pancreatic Insufficiency
- vitamin supplement

A

Vitamin A, D, E and K

81
Q

Deficiency of alpha-galactoside
- condition
- inheritance

A

= Fabry’s disorder
X-linked recessive

82
Q

Measure for survival time

A

Hazards ratio

83
Q

Management of magnesium sulphate toxicity

A

Calcium gluconate

84
Q

Polymyositis
Lung fibrosis
Rhabdomyolysis
- diagnosis
- pathophysiology of renal failure

A

Anti-Jo 1 syndrome
ATN due to rhabdomyolysis

85
Q

Management of Behcet’s

A

Prednisolone where there is eye involvement

86
Q

What is the effect of carbon monoxide on ventilation and inspiration?

A

Has no effect

87
Q

ECG signs of left ventricular aneurysm

A

ST elevation in V1-V3

88
Q

ECG signs of ischaemic cardiomyopathy

A

Poor R wave progression
LBBB

89
Q

Conversion of PO to SC morphine

A

1/2 the oral dose

90
Q

Management of pulmonary hypertension in pregnancy

A

Stop dual endothelin receptor antagonist e.g. bosentan
Start LMWH as prophylaxis

91
Q

What cells are responsible for immune memory?

A

T cells

92
Q

What is responsible for draining the oesophagus?

A

Azygous vein - upper 2/3rds

93
Q

Management of dermatomyositis

A

Prednisolone
If not responsive trial azathioprine

94
Q

Biochemical picture in Addison’s disease

A

Hyperkalaemic metabolic acidosis

95
Q

Mechanism of action of baclofen

A

inhibits glutamate release

96
Q

What is at risk of injury when close to the right recurrent laryngeal nerve?

A

Right thyroid artery

97
Q

Management of hypocalcaemia/hyperphosphataemia in CKD

A

1st line - calcium acetate

98
Q

Which is associated with pulmonary haemorrhage - EGPA or GPA?

A

GPA - so raised transfer factor

99
Q

MND - two tests for prognosis

A

FVC
Sniff nasal inspiratory pressure

100
Q

1st management of spontaneous bacterial peritonitis

A

IV antibiotics
Wouldn’t do ascitic drain

101
Q

Rapid virilisation
Rapid onset puberty
Weight gain

A

Adrenal tumour

102
Q

What mineral often needs supplementing following gastric bypass surgery?

A

Zinc

103
Q

Sequence of events leading to T2DM

A

Ectopic fat deposition
Insulin resistance
B-cell failure

104
Q

Management of coronary artery vasospasm

A

Calcium channel blocker e.g. amlodipine

105
Q

Liddle VS Barter VS Gitelman

A

Liddle - hypertension, hypokalaemia, epithelial sodium channels

Barter’s - hypokalaemia, Na/K+/Cl- cotransporter

Gitelman - hypokalaemia, hypocalciuria
Na/Cl- thiazide sensitive channel

106
Q

Syndrome associated with breast, endometrial, thyroid and colon cancer
- genetic mutation

A

Cowden’s syndrome
PTEN

107
Q

CV defect in Noonan’s Syndrome

A

Pulmonary Stenosis

108
Q

Management of Tourette’s Syndrome

A

Psychoeducation
Clonidine
Risperidone

109
Q

Screening for haemochromatosis

A

General - transferrin saturation
Family - HFE genetic testing

110
Q

What is associated with TB management and drug induced lupus?

A

Isoniazid

111
Q

What activates macrophages?

A

INF-gamma

112
Q

What stage of mitosis does vincristine act on?

A

Metaphase

113
Q

Disinhibition
Gambling
Increased sweet tooth

A

Frontotemporal Dementia

114
Q

Grave’s Disease VS TMN on scintigraphy

A

Graves = uniform uptake
TMN = patchy uptake

115
Q

Where are SGLT2 channels?

A

EARLY proximal convoluted tubule

116
Q

Basophilic stippling is seen in….

A

Lead poisoning
Sideroblastic anaemia
B thalassaemia trait

117
Q

Isolated lymphocytosis
Smudge cells
- What is the diagnosis?
- What is the management?

A

CLL
FCR chemotherapy
= fludarabine, cyclophosphamide, rituximab

118
Q

Management of severe alcoholic hepatitis

A

Steroids

119
Q

What is the pattern in Brown-Sequard syndrome?

A

Contralateral temperature loss
(spinothalamic tract decusates at each level)

Ipsilateral loss of proprioception, vibration sense, spastic paresis

120
Q

Management of high altitude cerebral oedema

A

Descent + dexamethasone

121
Q

What does troponin I bind to?

A

actIn
(troponin C = calcium ions, troponin T = tropomyosin)

122
Q

What causes chancroid?
What is the presentation?

A

Haemophilus ducreyi
= do CRY about pain (painful lesion), usually travel history

123
Q

Investigation of choice for reflux nephropathy

A

Micturating cystogram

124
Q

What is the toxic product in paracetamol overdose?

A

NAPQI
= n acetyl p benzoquinonemine

125
Q

Young male
Arthralgia
Abdominal pain
Fever
Pericardial Effusion

A

Familial Mediterranean Fever

126
Q

Odds Ratio - how to calculate?

A

Did: Didn’t
VS
Did: Didn’t

127
Q

Specificity =

A

specifically negative
(negative + false positive)

128
Q

Sensitivity =

A

they are sensitive so it’s important to be positive

129
Q

Think celebrity is in love with them

A

De Clerambault’s syndrome

130
Q

What is associated with T1 cyroglobulinaemia?

A

Raynaud’s phenomenon
Membranoproliferative GN - common to all cryoglobulinaemias

131
Q

Side effect associated with sulphonylureas?
Example

A

Weight gain
Tolbutamide

132
Q

Management of OCD

A

Exposure response therapy

133
Q

Management options for vasodilator NEGATIVE pulmonary hypertension

A

PDE5 inhibitor e.g. sildenafil
Dual endothelin receptor antagonist e.g. bosentan
Prostacyclin analogues

134
Q

Biochemical abnormality seen in Cushing’s Syndrome

A

Hypokalaemic metabolic alkalosis
- think there is XS aldosterone = K+ loss, alkalosis

135
Q

Features associated with pancreatic cancer (2)

A

Double duct sign
Migratory thrombophlebitis

136
Q

What movement is reduced in adhesive capsulitis?

A

External rotation

137
Q

Which renal tubular acidosis is associated with renal stones?

A

T1 RTA
= too little acid in urine, alkaline urine, means that calcium and phosphate clump together = stones

138
Q

Phosphate abnormality in 1y hyperparathyroidism
- why?

A

Low phosphate
Reduced absorption/increased excretion of phosphate in proximal tubule

139
Q

Mechanism of action of pilocarpine

A

Muscarinic agonist

140
Q

Management of pulseless VT or VF - initial

A

Unsynchronised DC shock (nothing to synchronise to)

141
Q

What does the Golgi do?

A

Adds mannose 6-phosphate

142
Q

What is the first choice anti-depressant in ischaemic heart disease?

A

Sertraline

143
Q

How do you monitor haemochromatosis?

A

Ferritin

144
Q

COPD
- where will they see benefit in NIV?

A

If pH is 7.25-7.35

145
Q

Syringomyelia
- which tracts affected and where?

A

Spinothalamic tract - because they decussate at the anterior white commissure

146
Q

What immunodeficiency predisposes to SLE?

A

C1q, C1rs, C2 and C4

147
Q

Sudden painless loss of vision
Multiple retinal haemorrhages
Diagnosis?

A

Central retinal vein occlusion

148
Q

Which cells in stomach secrete stomach acid (and so gastrin acts on)?

A

Parietal cells

149
Q

HLA loci associated with RA

A

HLA DRB1

150
Q

What technique is used for oncogene detection?

A

PCR

1MRCP Part 1 (20 decks)

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