Past Papers Flashcards
What kind of optic neuritis do you see in MS
Inflammatory Optic Neuritis
What kind of optic neuritis do you see in GCA
Ischaemic Optic Neuritis
Altered bowel habits
Los of weight
Ascitis in females
What should you think of
Ovarian Ca
What is the Mx of HUS
Eculizumab
What is the Ix of Choice for MND
EMG
What infection is transmitted through Unpasteurised milk
Listeria
Mx: Amox
What is the relation between Beta HCG and hyperemsis with TSH and thyroid
Beta HCG is similar to TSH and so stilulatesTHyroid hormone release and Low TSH
Once Hyper-emesis settles;
TSH will also settle
Conservative mx only
Juts repeat TFT’s in 4 weeks
What is the relation between SS and Altered bowel habits. What should you think of
SIBO
Ix; Hydrogen breath test/ Carbohydrate Breath test
Mx:
Metronidazole/ Rifaximin
What drug can you use to treat / reduce lytic bone lesions in MM
Denosumab ( RANKL inhibitors)
What do you if someone Receiving Vanc, develops allergies
Stop Transfusion, give anti-histamines and hydrocortisone and restart infusion at Half speed.
Vancomycin Red Man Syndrome
What is the Mx of Lambert Eaton Syndrome
Amifampridine
Brazil
AV Block
Oesophageal problems
What is the Dx
Chagas disease
Triotamine bugs ( bite/ faeces)
Mx: Benzinidazoles
What is the drug of choice in inducing remission in Membranous GN
Rituximab
What is the MOA of Vedolizumab
Integrin Antagonist
Unstable possible PE
What is the best initial Ix
Bedside Echo
Definitive ; CTPA
Pt. with short bowel syndrome - what stones are they at a risk of
Oxalate stones
Which Abx is safe in pregnancy In 1st Trimester for UTI
Nitrofurantoin
Post PCI for inf. MI
Pt. has asymptomatic broad complexes. What do you do
Observation only
What Is the 1st line Mx for urianry problems for acute symptoms in BPH
Doxazosin - Alfa blocker
( relaxes bladder muscle)
Rapid action
Note:
Long term;
Use Finasteride ( 5 alfa reductase inhibitors)
Reduces prostate size and prevents progression
( takes time to act)
What is the 1st line Mx of Osteomyelitis in diabtetics
Co-amox - 1st line
2nd line - Clindamycin
Anal itching ; worse at night
Thread worms;
Mx: Mebendazole
What is the most common cause of SBP In someone having peritoneal Dialyiss
Staph Epidermis
( Coag -ve staph)
What is the 1st line Mx for Ig A nephropathy
Ramipril
What is the 1st line Mx for Minimal Change Nephropathy
Prednisolone
What is the Mx of HRS
1st - Terlipressin
2nd - TIPPS
If a young Pt. goes into VT arrest / or arrests when at rest.
What should you think
Brugada Synd.
Note;
In HOCM - it usually when physically exerts themselves
in Congenital Qt prolongation - Usually after stressorss/ exerse/ emotion change, etc
What group is mirabegron
Beta 3 - Adrenergic Agonist
What is the mx of Otitis Externa
Cipro/ Dexa ear drops
if Severe- oral Fluclox
What is the most specific mx for Waldesteroms
Dexamethasone + Rituximab (*) + Cyclophopshamide
(DRC)
Note: Plasmapheresis - Initial Mx
( especially if hyperviscosity +)
How many PVC - premature ventricular ecliptics are considered normal in a day
Normally heart beats ; 100,000 times a day
(<10,000) / 10%)
What is Digifab/ Digoxin Immune Fab
Digibind
Used to Tx digoxin toxicity
Note:
in chronic toxicity; use half the dose of digibind
What is Neuroborreliosis
Lymes ( Borrelia Burgoderfi)
With neuro symptoms
Mx:
Doxy
What is the criteria for poor prognosis in Liver Failure NOT related to PCM toxicity
Pt <11 or >40
Bili levels >300
Time of onset of jaundice to time of coma >7 days
INR>3.5
Drug toxicity ; even if not the cause of liver Failure
What is the cause of raised Chloride in post DKA recovery
Plasma Volume Expansion
What is dialysis disequilibrium syndrome
🔹 Definition: Neurological disorder due to rapid urea removal during dialysis, causing cerebral edema.
🔹 Pathophysiology:
Rapid ↓ in plasma urea → osmotic gradient → water shifts into the brain → brain swelling.
🔹 Risk Factors:
✅ First dialysis session
✅ High pre-dialysis urea (>40 mmol/L)
✅ Rapid urea clearance (>50% in one session)
✅ Young patients, elderly with cerebral atrophy
🔹 Clinical Features:
🚨 Mild: Headache, nausea, vomiting, blurred vision, cramps
🚨 Severe: Confusion, agitation, seizures, coma, hypertension, raised ICP
🔹 Prevention:
✅ Slow initial dialysis (reduce urea clearance rate)
✅ Lower blood flow rate
✅ Use lower dialysate sodium concentration
✅ Mannitol or hypertonic saline to counteract osmotic shifts
🔹 Management:
1️⃣ Supportive care (oxygen, airway protection)
2️⃣ Hypertonic saline / Mannitol (reduce cerebral edema)
3️⃣ Reduce dialysis rate or stop temporarily
4️⃣ IV benzodiazepines for seizures
How do you treat AF in asthmatics wo are tachycardia
Verapamil
When do you consider Elective intubation in someone with myasthenia
FVC <20ml/kg
What is a major serious side effect of Bisphosphonates
Osteonecrosis of the jaw
What is the mx of granulomatosis with polyangitis
1) Methyl pred with cyclophosphamide
Note:
If young women, who have not yet completed family;
Metyl pred + Rituximab
( due to its reduced gonadotoxity)
What is the pathology in retinitis pigmentosa
Progressive retinal photoreceptor degeneration
Mx of acute dystonia
Procyclidine
Diphenhydramine
What is the most imp cofirmation for brain stem death
Apneoa Testing
What is the best way to manage anticoagulation in hospital with someone who has severe renal dysfunction
Unfractioned Heparin
HB post inf. Wall MI.
What do you do
Observation only
Note:
if Ant wall MI –> needs intervention
What is the main reason to continue the basal insulin when pt. on FRII
To prevent rebound Hyperglycemia when FRII is stopped
Long term urinary catheter
No symptoms
Incidental E.coli
What do you do from below
Change catheter vs Reassurance
Reassurance
If no symptoms whatsoever; juts reassurance
Catheter change only if symptoms persist.
What is Miller Fischer a variant of
Gb synd with eye inv.
Antibodies against GQ1b is +++
Mx: IVIG/ Plasma Exchange
What is the Mx of HUS
Plasma Exchange - especially if neuro symoptoms ;
Eculizumab → Used in atypical HUS (aHUS) (complement-mediated)
How do you treat CO poisoning In someone with COPD whoa re going into type2 RF
NIV
( imp .to maintain as high O2 as possible - to treat CO poisoning)
( im ot flins out CO2 as well - So NIV)
How do you interpret High dose Exam Test
If Cortisol drops <50% from baseline - Cushing Disease ( Central ACTH suppressed)
If failure to drop <50% from baseline;
Adrenal tumour or ectopic ACTH
What is the Ix of choice for CLL
Immunophenotyping
( CD5, CD19, CD20, CD23)
What is the Mx go Gonorrhoea
Ceftriaxone - 1g x IM
or
Azithro x 2g x PO
?PE in pregnancy what should you do
if ?DVT
1st do doppler as safe and no radiation
How do you mx Bone mets
1st - start with bisphosphonates
( Ibandronate)
Much easier and quicker to start
2nd - Radiotherapy
What is the next line Mx of COPD if first 3 lines fail
Roflumilast ( Phosphodiesterase inhibitors type4)
Mid-systolic click followed by late systolic murmur over Apex
MVP
( seen In Ehler Dan’s / Marfans)
When do you do adrenal vein sampling
When adrenal tumour Is not found on Imaging when looking for hyperaldosteronism
Barrets with low grade dysplasia
What is the mx
Radiofreqeuncy ablation
Note:
If dysplasia is not confirmed yet, then survellience every 6 months
What is the mx of Candida Albicans of system infection
1) Caspofungin
2) Amphotericin B
Salmon pink rash
Evening fevers
Joint pains
Raised Ferritin
Negative - autoimmune screen
Adul Onset Stills
Thyroid eye disease; key Mx
Prednisolone
Food feels like sticking
Usually after midline radiotherapy ;
or Tx for Hodsgkinds
No weight loss
What is the Dx
Oesophageal Stricture
Note: in Achalasia;
they’re will be symptoms of dysphagia to solids and liquids
Pt. having chemo for oncology and in hospital.
What is the mx option for blood thinning
Dalteparin
HSMN1 (CMT1) - MRCP Key Features
Autosomal dominant PMP22 gene duplication (CMT1A most common)
Early onset with distal muscle weakness (foot drop), pes cavus, and areflexia
Distal sensory loss (vibration/proprioception
“Champagne bottle” legs due to calf wasting
Demyelinating neuropathy → Slow conduction velocity on nerve studies
Supportive management (physiotherapy, orthotics, pain relief)
💡 MRCP Clue: “Pes cavus, foot drop, slow conduction = CMT1
What is an alternative to erythropoietin in CKD
Roxadustat -
Hypoxia Inducible Factor 1
What is the reaction between Indapamide and Gout
Nil
Thaizide Like diuretics do NOT cause GOUT unlike thiazides and are safe
Radiation therapy from Hodgkins can lead other which Ca
Breast Ca
What is the Mx of Androgen Insensitivity Syndrome.
Oestrogen Ony
NOTE:
They do not have a Uterus and so no Use of Progesterone
Which is the vaccine to avoid in HIV irrespective of what the CD4 count is ;
Live Attenuated Influenza Vaccine
LP shows;
Normal Glucose and Protein
Lymphocytic Pleocystosis
Viral Meningitis
What is the 1st line Mx drug for Juvenile Myoclonic Epilepsy
First-line treatment for Juvenile Myoclonic Epilepsy (JME) → Valproate
💡 MRCP Clue: “Teenager with morning myoclonic jerks → Valproate”
🔹 Alternatives if Valproate contraindicated (e.g., women of childbearing age):
Levetiracetam
Lamotrigine (less effective for myoclonic seizures)
Topiramate (less commonly used)
⚠️ Avoid: Carbamazepine & Phenytoin (can worsen myoclonic seizures)
What is the 8 hr threshold to stop NAC in PCM x OD
If levels < 50mg/l
If still above this -:> comtinue
Note:
At 4 hrs; cutoff is 100mg/l
which time of the day - cardiac pauses are considered more significant
Day time pauses
How do you manage Steroid induced Diabetes
Insulin - Glargine
What is the mx of ESBL +ve E.coli for UTI
Fosfomycin
Carbapenems such as meropenem/ Imipenem
What type of Glycogen disorder is McArdle
Glycogen type V
in which vasculitis do you see sinusitis
in
Granulomatosis with polyangitis ( GPA)
PR3 +/ C-ANCA
NOT in EGPA
What is the 1st line Ix for Urge Incontinence
Post void -residual urine volume
What is 1st ine Mx of PD
Levodopa
Non ergot derived dopamine agonist
( Ropinorole)
Note:
Entacope is used as an add on in late PD to better effects of Levodopa
What is the mx of Aspirn/ Salicyate pisioing
within 1st Hour
If between 250-500mg/kg - Activated Charcoal
If >500 —> Gastric Lavage
if >500; after 1st
Urine Alkalinsation with sodium Bicarbonate 8.4%
For HD
if >700 with met acidosis
or >900
or coma
MRCP Clues to Remember: Gauchers
Massive splenomegaly + pancytopenia + bone crises = Gaucher’s Disease
Gaucher cells = Lipid-laden macrophages (crumpled tissue paper appearance)
Foam Cells
ERT is the mainstay of treatment (Imiglucerase)
Which anti-diabetic drug helps reduce Kidney stones
SGLT-2
What re the key differences between cervical spondylosis and cervical myelopathy
MRCP Clues to Remember:
Spondylosis = Local + Radicular symptoms (LMN signs in arms only).
Myelopathy = Cord involvement (UMN signs, gait disturbance, spasticity).
MRI is the best test for both.
Surgery (decompression) is needed for progressive myelopathy.
What is the Mx of Cat scratch fever
Azithromycin
what % of EGFR drop is normal in 1st 1-2 weeks after starting ACE
25%
CYP3A4 inhibitor
Carbamazepine
Audi “A4” is a “Car”
ECOG Performance Status (Eastern Cooperative Oncology Group Scale)
The ECOG performance status is used in oncology and palliative care to assess a patient’s ability to perform daily activities. It helps guide treatment decisions, prognosis, and clinical trial eligibility.
🔢 ECOG Scale:
0 – Fully active; no restrictions
1 – Restricted in strenuous activity, but can do light work
2 – Ambulatory, can care for self, but unable to work
3 – Limited self-care, bed/chair >50% of the day
4 – Completely disabled, bedridden
5 – Death
📌 MRCP Clue:
ECOG 0–1 → Fit for chemotherapy
ECOG 2 → Consider chemo but assess risks
ECOG 3–4 → Supportive care preferred
what is the pulm artery HTN classification
📌 MRCP Clues:
Group 1 (PAH) → Treat with pulmonary vasodilators (e.g., Sildenafil, Bosentan)
Group 2 (LHD) → Treat underlying heart disease (Diuretics, ACEi, β-blockers)
Group 3 (Lung disease) → Treat lung disease (Oxygen, CPAP for OSA)
Group 4 (CTEPH) → Pulmonary endarterectomy or Riociguat
Group 5 (Mixed causes) → Treat underlying disorder
What toxin is released by Staph in Impetigo
Exfoliative toxin A
Secretion of different pancreatic cells
Alpha Cells: Secrete glucagon to increase blood glucose levels.
Beta Cells: Secrete insulin to lower blood glucose levels.
Delta Cells: Secrete somatostatin to inhibit insulin and glucagon release.
PP Cells: Secrete pancreatic polypeptide (PP) to regulate pancreatic enzyme secretion and gastric motility.
Epsilon Cells: Secrete ghrelin to stimulate appetite and regulate energy balance.
Acinar Cells: Secrete digestive enzymes (amylase, lipase, proteases) to aid in digestion.
Ductal Cells: Secrete bicarbonate to neutralize stomach acid in the duodenum.
What lung features can we see in Bronchial Carcinoid
Recurrent Pnuemonias;
Infections
Non smokers
What is the Mx of hemiplegic migraine
( stroke like migraines)
Naproxen
What is the best ventilation setting for covid
Low tidal volume (6ml.kg) , Low driving pressures(30cm H20), High PEEP (15cm H20)
Coeliac disease
Increase in diarrhoea despite Gluten free Diet and loss of weight
Bowel Lymphoma
ix:
MRI of abdomen
how do you differentiate it from Langerhans cell Histcytosis
Key MRCP Clue to Differentiate:
Young woman + diffuse cysts + chylous effusion + angiomyolipomas → Think LAM
Young smoker + upper lobe cysts + nodules → Think LCH
What cells do you see In acute Interstitial nephritis in Biopsy
T lymphocytes and monocytes
What is the Mx of Cutaneous Leishmaniasis ( Brazil)
Paromomycin
What bowel Problem is Scleroderma usually associated with
SIBO
ix:
Hydrogen breath test
Brucellosis with Discitis
What is the Mx
Doxy + Streptomycin
What bore chest drains do you use in pneumothorax
Small bore
LArge bore- usually I trauma cases where there is blood as well
Pt. has acitis not controlled with spirnolocatone alone
What do you do
Add Furosemide
Elevated adenosine Deaminase in Peritoneal Fluid
What is the Dx
TB
What is the genetics between transformation of MGUS to MM
Activation of myc gene
Juvenile myoclonic Epilepsy
What is the first line Mx
Levetiracetam
what is the best drug to control HTN In pt. in CKD having dialysis
Beta Blockers
If you want to treat Molluscum ; how do you treat it
podophyllitoxin
What is the bowel screening classification for risk of colon Ca
if 1 or less relative died - Low risk
if 2 relatives dies - Medium risk
if >3 relatives died - High Risk
Screening ;
If low risk - usually Uk screening at 60 years
if medium risk - screening at 55 years
If High risk - at 40 years
Lung Ca after Mx of Breast Ca caused by
Radiotherapy
Note:
Tamoxifen increased uterine ca risk
What drug should you stop when someone has SBP and is on Tx for Liver disease
Carvidilol
What drugs increase Lithium toxicity
Naproxen, Thiazides
What is the mutation in Gittleman Synd
Na-K-Cl Co-transport
