Past papers Flashcards
(175 cards)
1
Q
What is the most useful way to differentiate toxoplasma infection?
A
CSF PCR
(IgG antibody titre is less reliable given high chance of previous exposure)
2
Q
Which enzyme transports fatty acids within the cell?
A
Carnitine acyltransferase
Carnitine deficiency in kids can lead to cardiomyopathy
3
Q
Initial intervention for toxoplasma?
A
Pyrimethamine
4
Q
What is Charles Bonnet syndrome?
A
syndrome of visual hallucinations with preserved consciousness associated with visual impairment
5
Q
Latex fruit syndrome
A
Bananas, kiwis, avocados
6
Q
Ragweed allergy
A
Food allergies to banana and melon
7
Q
Avoidant vs schizoid personality disorder vs schizotypal
A
Avoidant - has a need for human contact and feels lonely, anxiety is limiting socialisation
Schizoid - emotional aloofness, indifference to praise or criticism
Schizotypal - schizoid + abnormalities of thought
8
Q
Medical management of bowel ischaemia
A
Fluids and analgesia
no role for steroids
9
Q
Common peroneal nerve palsy vs L5 lesion
A
Preserved foot inversion and plantar flexion = common peroneal nerve palsy
10
Q
Medication causing acute pancreatitis
A
furosemide
11
Q
Carbamazepine MoA
A
Voltage dependent sodium channel inhibition
12
Q
Somatostatinoma symptoms
A
Pentad of DM, cholelithiasis, weight loss, steatorrhoea and diarrhoea and hypochlorhydria
10% assoc. with NF-1
45% assoc. with MEN-1
Can secrete VIP, insulin, gastrin, ACTH calcitonin and pancreatic polypeptide
13
Q
Engorged episcleral vessels, gritty feeling, watery eyes- diagnosis?
A
Episcleritis
14
Q
Medication that worsens psoriasis symptoms?
A
beta blockers
15
Q
Poor prognostic factors in infective endocarditis
A
S. aureus infection
Prosthetic valve
Culture negative infection
Depletion of complement levels
Strep. infection = better prognosis
16
Q
Alpha-1 antitrypsin deficiency genetics
A
SERPINA1 gene mutation
Autosomal codominant
PiMM = normal
PiZZ = severest homozygous form
A1 antitrypsin = alpha 1 proteinase inhibitor made in liver
Mutations -> abnormal protein accumulation in liver causing scarring -> cirrhosis
Deficiency -> accumulation of neutrophil elastase in lungs -> emphysema
17
Q
Tertiary syphilis vs Yaws
A
Tertiary syphilis - confusion, dorsal column involvement, nodular rash, West Africa
Yaws- ulceration of palate and nasopharynx, subcutaneous nodules, osteoperiostitis
18
Q
Hypopigmented macular lesions with decreased sensation in the centre?
A
Tuberculoid leprosy
19
Q
Which cytokine production is reduced by ciclosporin?
A
IL-2 (aka T cell growth factor)
20
Q
Which cytokine production is reduced by tacrolimus?
A
IL-2
21
Q
Treatment of prolactinoma
A
Dopamine agonists - cabergoline, ropinirole, bromocriptine
22
Q
Medications that worsens myasthenia gravis
A
Calcium channel blockers
Beta blockers
23
Q
Treatment of cat scratch disease (Bartonella henselae)
A
If not immunocompromised - reassurance as likely to self resolve
If immunocompromised - ciprofloxacin or azithromycin
24
Q
Metabolic acidosis + QRS >100 in overdose
A
Sodium bicarbonate due to risk of ventricular arrhythmia
25
Gynaecomastia, tall stature, microochidism, hypergonadotrophic hypogonadism
Klinefelter syndrome
26
Most concerning complication of recurrent gonorrhoea infection
Infertility
27
Fitz Hugh Curtis syndrome
Peri hepatitis secondary to chlamydia or gonorrhoea
28
Jarisch-Herxheimer reaction
transient reaction secondary to antibiotic administration for sphirocyte infection (syphilis, lyme disease, leptospirosis)
29
Autoimmune hepatitis vs PBC vs PSC antibodies
AH - anti-smooth muscle
PBC - anti-mitochondrial
PSC - assoc. w/ IBD
30
Pleural fluid pH < 7.3
malignant effusion
31
Indications for surgery in IE
-cardiac failure
- haemodynamic instability
-large vegetations
-septic emboli
-septal abscess (prolonged PR interval)
-fungal infection
- failure to respon to abx after 5 days
32
Normal bladder emptying occurs because of...
increased parasympathetic activity of S2-S4
hyperactivity treated with muscarinic antagonists
33
Hyponatraemia in lung Ca
Small cell
can also occur in mesothelioma
34
Necrotic changes around stoma site?
Pyoderma gangrenosum
35
Hepatitis with mixed cryoglobulinaemia and consequent renal impairment
Hep C > hep B
36
Best antidepressant while breastfeeding
Sertraline
Fluoxetine and citalopram accumulate
37
Diagnostic test for Wilson's disease
liver biopsy
38
Most common renal manifestation of tuberous sclerosis
angiomyolipomas
can be detected on USS or MRI
39
Risk factors for sudden cardiac death in HOCM
non-sustained VT
family history
syncope
LVH
40
Enlarged left atrium in HOCM increases risk of
AF
41
Clopidogrel MoA
binds to P2Y12 component of ADP on platelet surface, preventing platelet aggregation
same as ticagrelor
42
TTP symptoms
Thrombocytopaenia
Microangiopathic haemolytic anaemia
Neurological symptoms
Fever
Renal impairment
43
Shingles virus
Herpes zoster
44
Goserelin MoA
GnRH agonist
45
Thyroid cancer associated with MEN 2
Medullary thyroid cancer
Amyloid deposits on aspiration
46
Why monitor for osteoporosis in patients on levothyroxine?
Increase osteoclast numbers and activity lead to increased bone turnover
47
Cardiac lesion most associated with coarctation of aorta
bicuspid aortic valve
48
Treatment for alopecia areata
Intralesional corticosteroids
49
Uhthoff's phenomenon
worsening of MS symptoms after heat exposure
50
Inheritance pattern of Turner syndrome
No inheritance pattern
Random error of non-disjunction -> 45X
51
Gram positive rods meningitis in immunocompromised patient
Listeria
treat with ampicillin/amoxicillin
also occurs after eating unpasteurised foods
52
Extensive skin thickening + Raynaud's
diffuse cutaneous systemic sclerosis
Anti-topoisomerase I antibody
53
Most likely arrhythmia in WPW patient
AVRT
54
Most common causative organism of anterior blepharitis
Staph aureus
55
Treatment for avascular necrosis
Core decompression with bone grafting
THR for older patients
56
Bowel obstruction anti-emetic
haloperidol
57
Fear of germs
Mysophobia
58
Treatment of gastric MALToma
H pylori eradication
*even if negative test*
59
Genetics of Fabry disease
X linked recessive
alpha galactosidase a enzyme deficiency
60
Port wine stain + epilepsy + cognitive impairment
Sturge-Weber syndrome
epilepsy secondary to leptomeningeal angiomas
61
Treatment of serotonin syndrome
Benzodiazepines and cyproheptadine (histamine antagonist)
62
Contraindication to pneumonectomy
vocal cord palsy
implies local invasion of tumour
FEV1 < 0.8 predicted post pneumonectomy
SVCO
63
Treatment of lupus
hydroxychloroquine for joint disease
mycophenalate mofetil for renal disease
64
Function of lysosomes
Protein degradation
65
Witnessed and monitored VF/VT arrest management
3 successive shocks at same joules
then cpr
then increase joules
66
Calculating osmolarity
2 x Na + 2 x K + glucose + urea
67
Fixed split second heart sound
Ostium secundum ASD
68
Pansystolic murmur loudest at left lower sternal edge
VSD
69
Grapefruit juice effect on statin metabolism
CYP3A4 inhibitor
tf. increases statin bioavailability
70
Gag reflex innervation
sensory - CN IX
motor - CN X
71
Complications of infliximab
Reactivation of TB
Worsening of hepatitis
72
Actions of BNP
Sodium excretion
Reduced renin
Reduced aldosterone
73
Paralysed hemidiaphragm pulmonary function tests
Reduction by 30% of FVC
74
How do B cells change from producing IgM to IgG
switching of the constant region of the heavy chain
75
Greatest risk factor for future diabetic ulcer
Previous diabetic ulcer
76
Sight threatening thyroid eye disease symptoms
Loss of colour vision and blurred vision
suggest pressure on optic nerve
77
Hep A
faeco-oral transmission
self limiting
often associated with short diarrhoeal illness
78
Gull wing/inverted T pattern on X ray
Erosive osteoarthritis
79
Somatisation disorder
Multiple physical symptoms lasting 2 years or more
80
Vitamin C is essential for which process of collagen synthesis
Hydroxylation of proline and lysine
81
Pemphigoid
spares buccal mucosa
autoantibodies to hemidesmosomal BP180 and BP230
82
Pemphigus
involves buccal ulceration
desmoglein 3 and 1 antibodies
83
Long term immunosuppression and skin lesion
SCC most likely
84
Malignancy associated with Hashimoto's thyroiditis
Non-Hodgkin's lymphoma
Papillary thyroid
85
DNA splicing
removes introns (non-coding sequences of RNA)
86
Initial driver of T2DM
ectopic fat deposition
87
Most common deficiency after gastric bypass surgery
Zinc
88
Epilepsy with lip smacking and feelings of deja vu
Temporal lobe epilepsy
89
Abx for close contacts of pt. with meningococcal meningitis
ciprofloxacin
90
MND treatment
Riluzole (glutamate release inhibitor)
91
Dermatomyositis
CK elevated
Anti-Mi-2 positive (in 25% of pt)
92
Swollen, oedematous and erythematous rash after insect bite
Erysipelas - strep. pyogenes
treat with co-amox
(clari and met if pen allergic)
93
Low faecal elastase
Chronic pancreatitis
94
ECG leads posterior descending artery
V1 V2
the circumflex supplies the posterior surface of the heart, via the posterior descending artery in around 15% of people, called a left dominant system;
in 85% of people, the posterior descending artery arises from the right coronary artery, called a right dominant system.
95
Left anterior descending
V2-V5
96
Cowden syndrome
PTEN (phosphate tensin homologue) mutation
AD
Breast, thyroid, endometrial and colon ca
97
Strep. gallolyticus
= strep bovis
risk of colon cancer
98
First line treatment for acromegaly
pituitary surgery
pegvisomant is for persistent elevated GH post surgery
99
Noonan syndrome
neck webbing
short stature
undescended testes
cognitive impairment
assoc. pulmonary stenosis
AD - PTPN11 gene
100
Best marker to measure post-thyroidectomy for cancer recurrence
thyroglobulin
101
95% Confidence interval
2 standard deviations above and below mean
102
Adjustment disorder
emotional/behavioural reaction to significant life event
symptoms start within 3 months of event and are completed by 6 months
103
Lambert Eaton myasthaenic syndrome treatment
1st line - Amifampridine (3, 4 diaminopyrimidine)
2nd line - pyridostigmine
104
Abx for cellulitis in DM
Co-amox
105
IE management
Native valve - IV amox + gent
Prosthetic valve - vanc + gent + rifampicin
Staph - fluclox (+ rifampicin and gent if prosthetic valve)
MRSA - vanc + rifampicin
HACEK - amox + gent (consider cef + gent)
Strep - benpen
Q fever - doxycycline and hydroxychloroquine
106
Where is CSF absorbed?
Arachnoid granulations
(Choroid plexus produces CSF)
107
Nucleoside reverse transcriptase inhibitors
Lamivudine, zidovudine, tenofovir
108
Non-nucleoside reverse transcriptase inhibitors
Efavirenz
Nevirapine
109
Integrase inhibitors
Raltegravir, elvitegravir
110
Protease inhibitors
ritonavir, daranuvir
111
Where are beta 3 receptors found
Adipose tissue
112
Treatment of chlamydia in pregnancy
Azithromycin
(doxy is contraindicated as it leads to tooth staining)
[erythromycin or amoxicillin]
113
Drugs that reduce thyroxine absorption
Omeprazole
Iron
Bile acid resins
Phenytoin
114
Pregabalin MoA
voltage gated calcium channel inhibitor
115
Effect of calcitonin
Inhibits osteoclast activity
116
Which pituitary hormone falls in pregnancy
growth hormone (rises initially but begins to fall at week 15-17)
117
Parkinsonism with poor response to levodopa + postural hypotension
Multi-system atrophy
PSP - vertical gaze palsy and no postural hypotension
118
Causes of wide pulse pressure
aortic stiffness
aortic regurge
high output heart failure (seen in hyperthyroidism)
119
Dialysis related peritonitis cause
staph epidermidis
(coagulase negative)
treat with vanc - usually methicillin resistant
120
Cocaine induced MI
GTN then PCI
121
What is most associated with increased risk of heart failure with trastuzumab use
co-prescription of doxorubicin
122
Gold standard for leptospirosis diagnosis
Microscopic agglutination test
123
OCP reduces risk of which cancer?
colorectal
renal to a lesser extent
124
Best way to monitor disease progression in idiopathic pulmonary fibrosis
FVC
FVC most useful in monitoring restrictive lung disease
FEV1 most useful in monitoring obstructive lung disease
125
Main triggers for acne
In women:
Follicular epidermal hyperproliferation
In men + women with PCOS:
androgen excess
126
Medications causing sterile pyuria
NSAIDs
corticosteroids
PPIs
127
Parkinson's drug that potentiates risk taking and gambling
Ropinirole
128
Can you continue ACEi/ARB in pregnancy for HTN?
No - both are second trimester teratogens
Switch to labetalol
129
What type of receptor is insulin receptor?
Tyrosine kinase receptor
130
Site of action of ADH
cortical collecting duct
131
Primary action of insulin
Inhibition of gluconeogenesis
132
Which cancers does alcohol have biggest impact on risk
Mouth
Oesophageal
Breast
Colon
Liver
133
Treatment for constrictive pericarditis secondary to recurrent viral pericarditis
IL-1 antagonist eg. Anakinra
Then pericardectomy if no improvement
Furosemide provides symptomatic relief
134
RMSF via lyme disease
RMSF (rickettsia rickettsi) = macular rash
lyme disease = erythema migrans
135
Most common defects in HOCM
myosin binding protein C
beta myosin heavy chain 7
136
AST:ALT ratio >/= 2
Alcoholic liver disease
137
Best antihypertensives to use with lithium
CCBs
Beta blockers
ACEi, ARBs and diuretics lead to accumulation of lithium and toxicity
138
Main constituent of gallbladder stones
Bile pigment
139
Most useful investigation in suspected IgA nephropathy
24 hour urine protein estimation
Renal biopsy reserved for those with marked proteinuria or those who don't respond to meds
140
HNPCC mutation
MutS homolog 2
141
Most frequent diseases causing haemoptysis
Bronchiectasis
TB
Fungal infections
Cancer
142
Diarrhoea following terminal ileum resection
Bile salt induced diarrhoea
Malabsorption -> excess bile salts in colon leading to irritation and diarrhoea
143
Diarrhoea associated with systemic sclerosis
Small bowel overgrowth syndrome
144
Physiological response to Valsalva maneouvre in healthy person
Increased intrathoracic pressure shifts blood from the pulmonary circulation to the left atrium, and also causes reduced systemic return to the right side of the heart.
JVP will increase initially and cardiac output drops. Heart rate, and therefore pulse, drops during phase 1 of Valsalva manoeuvre.
145
Which Ig responsible for hyperacute rejection
IgG
146
Microscopy in gout and pseudogout
Calcium pyrophosphate crystals cause pseudogout, and are seen on microscopy as positively birefringent rhomboid crystals. Gout crystals are needle-shaped with negative birefringence.
147
Dominant parietal lobe lesion symptoms
receptive dysphasia, dyslexia, inattention and sensory impairments, and also Gerstmann syndrome, which is characterised by finger agnosia, acalculia, agraphia and left–right limb disorientation
148
Which investigation is most useful to determine whether goitre is the cause of breathlessness?
Lung function tests
Flow volume loop
149
Associations of constrictive pericarditis
Hepatomegaly (most common)
Ascites
Pericardial knock
Pleural effusion (uncommon)
150
MI in relation to pregnancy
Coronary artery dissection
151
What structure is implicated in the pathophysiology of lipodermatosclerosis?
Hypodermis
152
Seborrheic dermatitis symptoms
erythematous scaly rash involving the nasolabial folds, eyebrows and mid sternum, with mild scaling of the scalp
153
Collapsing pulse
Moderate to severe aortic regurgitation
154
Anacrotic pulse
low volume pulse seen in aortic stenosis
155
Pulsus alternans
Severe LVSD - cardiomyopathy, HTN, AS
156
Pulsus bisferiens
Moderate to severe aortic regurgitation
157
Pulsus paradoxus
Tamponade
158
Risk factors for completed suicide
Male
Older age
Alcohol
Previous attempts
159
Single nucleotide polymorphisms
Swapping of one nucleotide for another
Most commonly found in non-coding DNA between genes
160
Which drug would be most likely to maintain sinus rhythm following DC cardioversion
Class IA (disopyramide phosphate, quinidine sulfate)
Class IC (flecainide acetate, propafenone hydrochloride)
Class III (amiodarone, dofetilide, dronedarone, sotalol hydrochloride)
Amoidarone > propafenone > sotalol
161
ISMN MoA
increased cyclic guanosine monophosphate production
162
Where is BNP released
myocytes in cardiac ventricles
163
Indications for ivabradine in HF
left ventricular ejection fraction of less than 35% + HR above 75 beats/min
164
Site of action of haloperidol
D2 receptor antagonist that acts on area postrema, which is a medullary structure controlling vomiting
165
What is the mechanism of renal injury with aciclovir?
crystalluria
166
Causative organism for acute epiglottitis
Haemophilus influenza
167
Best statins with warfarin
Atorvastatin/pravastatin
168
Gram positive diplococcus meningitis
Strep pneumoniae
treat with ceftriaxone and vancomycin
169
Chondrocalcinosis in hereditary haemochromatosis
secondary to pyrophosphate arthropathy
170
Treatment of oculogyric crisis
benztropine
procyclidine
diphenhydramine
171
ECG change in hyperkalaemia with highest risk of arrest
QT prolongation
172
APML treatment
all trans retinoic acid
t15,17
173
Most common abnormality in lung function testing in obesity
expiratory reserve volume
reduced even in moderate obesity
174
Recurrent calcium oxalate renal stones
potassium citrate
thiazide diuretics
175
SAAG > 11 indicates
portal HTN secondary to cirrhosis
