Past papers Flashcards
What is the most useful way to differentiate toxoplasma infection?
CSF PCR
(IgG antibody titre is less reliable given high chance of previous exposure)
Which enzyme transports fatty acids within the cell?
Carnitine acyltransferase
Carnitine deficiency in kids can lead to cardiomyopathy
Initial intervention for toxoplasma?
Pyrimethamine
What is Charles Bonnet syndrome?
syndrome of visual hallucinations with preserved consciousness associated with visual impairment
Latex fruit syndrome
Bananas, kiwis, avocados
Ragweed allergy
Food allergies to banana and melon
Avoidant vs schizoid personality disorder vs schizotypal
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
Medical management of bowel ischaemia
Fluids and analgesia
no role for steroids
Common peroneal nerve palsy vs L5 lesion
Preserved foot inversion and plantar flexion = common peroneal nerve palsy
Medication causing acute pancreatitis
furosemide
Carbamazepine MoA
Voltage dependent sodium channel inhibition
Somatostatinoma symptoms
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
Engorged episcleral vessels, gritty feeling, watery eyes- diagnosis?
Episcleritis
Medication that worsens psoriasis symptoms?
beta blockers
Poor prognostic factors in infective endocarditis
S. aureus infection
Prosthetic valve
Culture negative infection
Depletion of complement levels
Strep. infection = better prognosis
Alpha-1 antitrypsin deficiency genetics
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
Tertiary syphilis vs Yaws
Tertiary syphilis - confusion, dorsal column involvement, nodular rash, West Africa
Yaws- ulceration of palate and nasopharynx, subcutaneous nodules, osteoperiostitis
Hypopigmented macular lesions with decreased sensation in the centre?
Tuberculoid leprosy
Which cytokine production is reduced by ciclosporin?
IL-2 (aka T cell growth factor)
Which cytokine production is reduced by tacrolimus?
IL-2
Treatment of prolactinoma
Dopamine agonists - cabergoline, ropinirole, bromocriptine
Medications that worsens myasthenia gravis
Calcium channel blockers
Beta blockers
Treatment of cat scratch disease (Bartonella henselae)
If not immunocompromised - reassurance as likely to self resolve
If immunocompromised - ciprofloxacin or azithromycin
Metabolic acidosis + QRS >100 in overdose
Sodium bicarbonate due to risk of ventricular arrhythmia
Gynaecomastia, tall stature, microochidism, hypergonadotrophic hypogonadism
Klinefelter syndrome
Most concerning complication of recurrent gonorrhoea infection
Infertility
Fitz Hugh Curtis syndrome
Peri hepatitis secondary to chlamydia or gonorrhoea
Jarisch-Herxheimer reaction
transient reaction secondary to antibiotic administration for sphirocyte infection (syphilis, lyme disease, leptospirosis)
Autoimmune hepatitis vs PBC vs PSC antibodies
AH - anti-smooth muscle
PBC - anti-mitochondrial
PSC - assoc. w/ IBD
Pleural fluid pH < 7.3
malignant effusion
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
Normal bladder emptying occurs because of…
increased parasympathetic activity of S2-S4
hyperactivity treated with muscarinic antagonists
Hyponatraemia in lung Ca
Small cell
can also occur in mesothelioma
Necrotic changes around stoma site?
Pyoderma gangrenosum
Hepatitis with mixed cryoglobulinaemia and consequent renal impairment
Hep C > hep B
Best antidepressant while breastfeeding
Sertraline
Fluoxetine and citalopram accumulate
Diagnostic test for Wilson’s disease
liver biopsy
Most common renal manifestation of tuberous sclerosis
angiomyolipomas
can be detected on USS or MRI
Risk factors for sudden cardiac death in HOCM
non-sustained VT
family history
syncope
LVH
Enlarged left atrium in HOCM increases risk of
AF
Clopidogrel MoA
binds to P2Y12 component of ADP on platelet surface, preventing platelet aggregation
same as ticagrelor
TTP symptoms
Thrombocytopaenia
Microangiopathic haemolytic anaemia
Neurological symptoms
Fever
Renal impairment
Shingles virus
Herpes zoster
Goserelin MoA
GnRH agonist
Thyroid cancer associated with MEN 2
Medullary thyroid cancer
Amyloid deposits on aspiration
Why monitor for osteoporosis in patients on levothyroxine?
Increase osteoclast numbers and activity lead to increased bone turnover
Cardiac lesion most associated with coarctation of aorta
bicuspid aortic valve
Treatment for alopecia areata
Intralesional corticosteroids
Uhthoff’s phenomenon
worsening of MS symptoms after heat exposure
Inheritance pattern of Turner syndrome
No inheritance pattern
Random error of non-disjunction -> 45X
Gram positive rods meningitis in immunocompromised patient
Listeria
treat with ampicillin/amoxicillin
also occurs after eating unpasteurised foods
Extensive skin thickening + Raynaud’s
diffuse cutaneous systemic sclerosis
Anti-topoisomerase I antibody
Most likely arrhythmia in WPW patient
AVRT
Most common causative organism of anterior blepharitis
Staph aureus
Treatment for avascular necrosis
Core decompression with bone grafting
THR for older patients
Bowel obstruction anti-emetic
haloperidol
Fear of germs
Mysophobia
Treatment of gastric MALToma
H pylori eradication
even if negative test
Genetics of Fabry disease
X linked recessive
alpha galactosidase a enzyme deficiency
Port wine stain + epilepsy + cognitive impairment
Sturge-Weber syndrome
epilepsy secondary to leptomeningeal angiomas
Treatment of serotonin syndrome
Benzodiazepines and cyproheptadine (histamine antagonist)
Contraindication to pneumonectomy
vocal cord palsy
implies local invasion of tumour
FEV1 < 0.8 predicted post pneumonectomy
SVCO
Treatment of lupus
hydroxychloroquine for joint disease
mycophenalate mofetil for renal disease
Function of lysosomes
Protein degradation
Witnessed and monitored VF/VT arrest management
3 successive shocks at same joules
then cpr
then increase joules
Calculating osmolarity
2 x Na + 2 x K + glucose + urea
Fixed split second heart sound
Ostium secundum ASD
Pansystolic murmur loudest at left lower sternal edge
VSD
Grapefruit juice effect on statin metabolism
CYP3A4 inhibitor
tf. increases statin bioavailability
Gag reflex innervation
sensory - CN IX
motor - CN X
Complications of infliximab
Reactivation of TB
Worsening of hepatitis
Actions of BNP
Sodium excretion
Reduced renin
Reduced aldosterone
Paralysed hemidiaphragm pulmonary function tests
Reduction by 30% of FVC
How do B cells change from producing IgM to IgG
switching of the constant region of the heavy chain
Greatest risk factor for future diabetic ulcer
Previous diabetic ulcer
Sight threatening thyroid eye disease symptoms
Loss of colour vision and blurred vision
suggest pressure on optic nerve
Hep A
faeco-oral transmission
self limiting
often associated with short diarrhoeal illness
Gull wing/inverted T pattern on X ray
Erosive osteoarthritis
Somatisation disorder
Multiple physical symptoms lasting 2 years or more
Vitamin C is essential for which process of collagen synthesis
Hydroxylation of proline and lysine
Pemphigoid
spares buccal mucosa
autoantibodies to hemidesmosomal BP180 and BP230
Pemphigus
involves buccal ulceration
desmoglein 3 and 1 antibodies
Long term immunosuppression and skin lesion
SCC most likely
Malignancy associated with Hashimoto’s thyroiditis
Non-Hodgkin’s lymphoma
Papillary thyroid
DNA splicing
removes introns (non-coding sequences of RNA)
Initial driver of T2DM
ectopic fat deposition
Most common deficiency after gastric bypass surgery
Zinc
Epilepsy with lip smacking and feelings of deja vu
Temporal lobe epilepsy
Abx for close contacts of pt. with meningococcal meningitis
ciprofloxacin
MND treatment
Riluzole (glutamate release inhibitor)
Dermatomyositis
CK elevated
Anti-Mi-2 positive (in 25% of pt)
Swollen, oedematous and erythematous rash after insect bite
Erysipelas - strep. pyogenes
treat with co-amox
(clari and met if pen allergic)
Low faecal elastase
Chronic pancreatitis
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.
Left anterior descending
V2-V5
Cowden syndrome
PTEN (phosphate tensin homologue) mutation
AD
Breast, thyroid, endometrial and colon ca
Strep. gallolyticus
= strep bovis
risk of colon cancer
First line treatment for acromegaly
pituitary surgery
pegvisomant is for persistent elevated GH post surgery
Noonan syndrome
neck webbing
short stature
undescended testes
cognitive impairment
assoc. pulmonary stenosis
AD - PTPN11 gene
Best marker to measure post-thyroidectomy for cancer recurrence
thyroglobulin
95% Confidence interval
2 standard deviations above and below mean
Adjustment disorder
emotional/behavioural reaction to significant life event
symptoms start within 3 months of event and are completed by 6 months
Lambert Eaton myasthaenic syndrome treatment
1st line - Amifampridine (3, 4 diaminopyrimidine)
2nd line - pyridostigmine
Abx for cellulitis in DM
Co-amox
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
Where is CSF absorbed?
Arachnoid granulations
(Choroid plexus produces CSF)
Nucleoside reverse transcriptase inhibitors
Lamivudine, zidovudine, tenofovir
Non-nucleoside reverse transcriptase inhibitors
Efavirenz
Nevirapine
Integrase inhibitors
Raltegravir, elvitegravir
Protease inhibitors
ritonavir, daranuvir
Where are beta 3 receptors found
Adipose tissue
Treatment of chlamydia in pregnancy
Azithromycin
(doxy is contraindicated as it leads to tooth staining)
[erythromycin or amoxicillin]
Drugs that reduce thyroxine absorption
Omeprazole
Iron
Bile acid resins
Phenytoin
Pregabalin MoA
voltage gated calcium channel inhibitor
Effect of calcitonin
Inhibits osteoclast activity
Which pituitary hormone falls in pregnancy
growth hormone (rises initially but begins to fall at week 15-17)
Parkinsonism with poor response to levodopa + postural hypotension
Multi-system atrophy
PSP - vertical gaze palsy and no postural hypotension
Causes of wide pulse pressure
aortic stiffness
aortic regurge
high output heart failure (seen in hyperthyroidism)
Dialysis related peritonitis cause
staph epidermidis
(coagulase negative)
treat with vanc - usually methicillin resistant
Cocaine induced MI
GTN then PCI
What is most associated with increased risk of heart failure with trastuzumab use
co-prescription of doxorubicin
Gold standard for leptospirosis diagnosis
Microscopic agglutination test
OCP reduces risk of which cancer?
colorectal
renal to a lesser extent
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
Main triggers for acne
In women:
Follicular epidermal hyperproliferation
In men + women with PCOS:
androgen excess
Medications causing sterile pyuria
NSAIDs
corticosteroids
PPIs
Parkinson’s drug that potentiates risk taking and gambling
Ropinirole
Can you continue ACEi/ARB in pregnancy for HTN?
No - both are second trimester teratogens
Switch to labetalol
What type of receptor is insulin receptor?
Tyrosine kinase receptor
Site of action of ADH
cortical collecting duct
Primary action of insulin
Inhibition of gluconeogenesis
Which cancers does alcohol have biggest impact on risk
Mouth
Oesophageal
Breast
Colon
Liver
Treatment for constrictive pericarditis secondary to recurrent viral pericarditis
IL-1 antagonist eg. Anakinra
Then pericardectomy if no improvement
Furosemide provides symptomatic relief
RMSF via lyme disease
RMSF (rickettsia rickettsi) = macular rash
lyme disease = erythema migrans
Most common defects in HOCM
myosin binding protein C
beta myosin heavy chain 7
AST:ALT ratio >/= 2
Alcoholic liver disease
Best antihypertensives to use with lithium
CCBs
Beta blockers
ACEi, ARBs and diuretics lead to accumulation of lithium and toxicity
Main constituent of gallbladder stones
Bile pigment
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
HNPCC mutation
MutS homolog 2
Most frequent diseases causing haemoptysis
Bronchiectasis
TB
Fungal infections
Cancer
Diarrhoea following terminal ileum resection
Bile salt induced diarrhoea
Malabsorption -> excess bile salts in colon leading to irritation and diarrhoea
Diarrhoea associated with systemic sclerosis
Small bowel overgrowth syndrome
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.
Which Ig responsible for hyperacute rejection
IgG
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.
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
Which investigation is most useful to determine whether goitre is the cause of breathlessness?
Lung function tests
Flow volume loop
Associations of constrictive pericarditis
Hepatomegaly (most common)
Ascites
Pericardial knock
Pleural effusion (uncommon)
MI in relation to pregnancy
Coronary artery dissection
What structure is implicated in the pathophysiology of lipodermatosclerosis?
Hypodermis
Seborrheic dermatitis symptoms
erythematous scaly rash involving the nasolabial folds, eyebrows and mid sternum, with mild scaling of the scalp
Collapsing pulse
Moderate to severe aortic regurgitation
Anacrotic pulse
low volume pulse seen in aortic stenosis
Pulsus alternans
Severe LVSD - cardiomyopathy, HTN, AS
Pulsus bisferiens
Moderate to severe aortic regurgitation
Pulsus paradoxus
Tamponade
Risk factors for completed suicide
Male
Older age
Alcohol
Previous attempts
Single nucleotide polymorphisms
Swapping of one nucleotide for another
Most commonly found in non-coding DNA between genes
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
ISMN MoA
increased cyclic guanosine monophosphate production
Where is BNP released
myocytes in cardiac ventricles
Indications for ivabradine in HF
left ventricular ejection fraction of less than 35% + HR above 75 beats/min
Site of action of haloperidol
D2 receptor antagonist that acts on area postrema, which is a medullary structure controlling vomiting
What is the mechanism of renal injury with aciclovir?
crystalluria
Causative organism for acute epiglottitis
Haemophilus influenza
Best statins with warfarin
Atorvastatin/pravastatin
Gram positive diplococcus meningitis
Strep pneumoniae
treat with ceftriaxone and vancomycin
Chondrocalcinosis in hereditary haemochromatosis
secondary to pyrophosphate arthropathy
Treatment of oculogyric crisis
benztropine
procyclidine
diphenhydramine
ECG change in hyperkalaemia with highest risk of arrest
QT prolongation
APML treatment
all trans retinoic acid
t15,17
Most common abnormality in lung function testing in obesity
expiratory reserve volume
reduced even in moderate obesity
Recurrent calcium oxalate renal stones
potassium citrate
thiazide diuretics
SAAG > 11 indicates
portal HTN secondary to cirrhosis
